It occurs more frequently with tetralogy of Fallot, VSD and aortic stenosis. Endocarditis develops at sites of endothelial injury, where there is deposition of platelets and thrombi. Any condition that results in bacteremia may seed this platelet thrombi, predisposing the patient to infective endocarditis. Dental manipulations, urogenital surgery, and many other invasive procedures have been implicated as the cause for bacteremia, but there remains a significant number of patients with no etiology. Recently, the incidence of Staph.
Fungal endocarditis is associated with intravenous drug abusers and chronic indwelling catheters.
Any patient who has a fever without an obvious cause should be suspected of having endocarditis. Patients may have a variety of nonspecific symptoms including anorexia, malaise, headache, and arthralgias. It is important to remember that fever is the only symptom that is universally present. The second most important clinical finding is the presence of a new heart murmur. Often the appreciation of the cardiac murmur is made difficult by tachycardia associated with fever of irritability.