|Abstract||The investigation and management of infective endocarditis in the developed world have changed radically over the past 30 years. Non-invasive imaging, molecular science, diagnostic protocols, and curative surgery have all become commonplace, yet the incidence remains unchanged and annual mortality approaches 40%.|
The lack of impact of modern medicine reflects important changes in the causes of the disease. In Western populations in particular, chronic rheumatic heart disease is now an uncommon antecedent, whereas degenerative valve disease in elderly people, intravenous drug misuse, preceding valve replacement, or vascular instrumentation have become increasingly frequent, coinciding with an increase in staphylococcal infections and those due to fastidious organisms.
Furthermore, previously undetected pathogens are now being identified with the disease, and multidrug resistant bacteria challenge conventional treatment regimens. Meanwhile, rheumatic valve disease remains endemic in the developing world, where modern investigations and management are the privilege of the well off few who live in large urban areas.
This review outlines the modern understanding, investigation, and management of this perplexing and enigmatic condition.