The first step in diagnosing endocarditis is a review of your medical history and a physical exam.

As part of your medical history, your doctor will ask you:

• About your symptoms.
• If you have a heart murmur or have had valve replacement surgery.
• If you have any recent risk factors for a bacterial or fungal infection such as drug injection, dental procedures, or a catheter (such as a catheter for dialysis).

As part of your physical exam, your doctor will:

• Look in your eyes for small amounts of bleeding.
• Look at your skin for tiny purple or red spots (petechiae), tender bumps, or painless red spots.
• Listen to your heart for a murmur.
• Listen to your lungs for any fluid buildup.
• Give you a neurologic exam to check for signs of a stroke.

Other tests may be needed to diagnose endocarditis. They include:

• Blood cultures. Several blood cultures are recommended to identify bacteria or fungi in the bloodstream.¹ But sometimes blood cultures fail to detect endocarditis. The cultures may fail because you recently took antibiotics or the bacteria or fungi causing your endocarditis do not grow well in a lab culture. If the blood cultures do not detect endocarditis, you may need further testing.
• Echocardiogram, including transthoracic echocardiogram (TTE) and transesophageal echocardiogram. These tests use high-pitched sound waves to produce an image of the heart. They can find infected areas, heart valve defects, and other abnormalities.

You may need other tests to identify complications of endocarditis. These tests may include:

• Chest X-ray, which can show whether your heart is enlarged or you have signs of heart failure.
• Electrocardiogram (EKG, ECG). An EKG can determine whether your heart rhythm is regular. Endocarditis can cause abnormal heartbeats or an abnormal heart rhythm (heart block).
• Urinalysis, which checks for blood and protein in the urine.
• Computed tomography or an MRI. These tests can tell if a blood clot caused by endocarditis has caused a stroke or if the infection has spread to your brain.
• Cardiac catheterization. This test may be useful if you need to have valve replacement surgery because of endocarditis. It may also be used before valve surgery to see if you have coronary artery disease that should be treated at the same time.