The following are a list of symptoms which also apply to many other illnesses, though also clues to IE.

• fever

• pallor

• chills

• sweats, especially night sweats

• unusual fatigue

• exhaustion

• diarrhea

• vomiting
• persistent headache
• loss of appetite
• anemia 
• general malaise

• weight loss
• cough
• chest pain
• abdominal pain
• musculoskeletal arthralgias
• peculiar visual disturbances

Fever: A fever of unknown origin of a weeks duration in a patient with a known click and/or murmur should cause suspicion of IE.  Any new or change of murmur should also be considered.

Tachycardia: (rapid heart beat) This is also very common in cases of IE especially suspect if present with high fever.

Cardiac Enlargement: This can be caused by acute regurgitation from vegetation on the valves.  This enlargement will not likely show on an echocardiogram but will on a chest X-ray.

EXTERNAL SIGNS:

Petechiae: These are minute, rounded red spots with pale, whitish or yellowish centers. Found in the conjunctiva of  the eyes, the lids, in the eye itself (seen by eye examination), the oral muccosa of the mouth, and on the hands and feet.

Osler's Nodes:  These are tender, painful skin lesions. They are nodular, small, firm, raised reddish-purple sometimes with a whitish center.  They occur on the fingertips, the pads of the toes, soles of the feet, the skin of the lower arm, and sometimes the sides of the fingers. They may last for merely hours to several days.  Studies have shown that these are minute emboli which contain bacteria.

Janeway's Lesions: These are red spots on the skin, abundant, small hemorrhages, slightly nodular, found on the palms of the hands and soles of the feet.

Clubbing of the Fingers:  This is a broadening and thickening of the soft tissues of the ends of the fingers and toes. There is a margin of red skin around the nails indicating an active infection.

Splinter Hemorrhages:  These are tiny blood clots or emboli, broken off from the valve, traveling thru the blood stream to lodge in the finger nails. They are longitudinal, reddish-black and splinter-shaped.

Splenomegaly:  An enlarged spleen may be felt by a physician but may also be missed. Infected emboli may lodge  in the spleen, cutting off the blood supply in the area and destroying surrounding tissue. These emboli to the spleen cause local tenderness or pain in the left upper quadrant of the abdomen, radiating to the shoulder.

MUSCULOSKELETAL MANIFESTATIONS

Arthralgias:  Pain migrates from one joint to another and is the most common musculoskeletal sign of IE, 38%.

Arthritis:  Inflamed, swollen and painful joints occurs in 31% of patients with IE. Fluids may be obtained from the joints and analyzed for bacteria content.

Low Back Pain:  Occurs in 23% of patients.  There may be spinal tenderness and decreased motion, pain or spasm in the muscles.

Myalgias or Muscle Pain:  This is shown in 19% of patients.  It is believed that this pain could be caused by an   emboli in a small muscular artery or arteriole. This resulting in muscle cell destruction.

Hypertrophy Osteoarthropathy:  The fibrous membrane covering the surface of bones, becomes inflamed. One   patient complained of constant aching pain that prevented walking and sleeping, unrelated to motion, and  made more severe by local pressure.

NEUROLOGICAL MANIFESTATIONS:

      Warning signs that the central nervous system are involved are: decreased concentration, lethargy, auditory and visual hallucinations, emotional liability, personality and behavioral changes, euphoria, delirium and depression.  All these symptoms have been overlooked in many cases and chalked up to psychiatric or neurotic illness.

Cerebral Embolism:  Pieces of the bacterial vegetations break off, and travel through the blood stream to lodge in and artery of the brain.  Some embolus are so small nothing much is felt, perhaps a stiff neck or a head ache.  Larger embolus may cause paralysis, loss of speech or even death.

Mycotic Aneurysms: This is ballooning or dilation of an artery which can burst.  This is a result of an infected   embolus lodging in the walls of an artery, and is very hard to detect as it is asymptomatic until a rupture occurs.

Brain Abscess:  Emboli discharged from the heart at sites of vegetation, causing seizures and convulsions, the large   ones causing brain damage. The abscess occurs, not in the arteries, but surrounding perivascular tissues or  structures.

Meningoencephatitis:  This is the most common central nervous system disorder of IE. Meningitis is an   inflammation of the brain and its membranous coverings, called the meninges.   The inflammation itself is  usually the response of the surrounding tissues of the brain to a mycotic aneurysm or an embolus. The symptoms are rigid neck, cerebral edema, congestion and frequent hemorrhages of different sizes.

RENAL COMPLICATIONS: (of or concerning the kidneys)

         There are many people with chronic kidney problems who suffer greatly. IE may be completely undetectable unless a kidney biopsy is done on the tissue.  In acute cases there are obvious signs in the urine such as abnormal sediment, protein, blood, red and white blood cells and casts (tissue mold). There may also be signs of urinary retention, and tests may show retention of waste materials. In renal disease, potassium, sodium, calcium, glucose and fatty acids may be increased in the blood.