When should I consider referring a patient with suspected infective endocarditis to a specialist?

Consider referring a patient with suspected infective endocarditis to a specialist urgently if they have clinical features suggestive of valve disease or complications related to endocarditis. This includes patients with a new or changing murmur, signs or symptoms such as breathlessness, angina, peripheral oedema, or abnormal ECG findings that may indicate valvular involvement. Urgent referral should be made within 2 weeks, especially if there is a systolic murmur with exertional syncope or severe symptoms like angina or breathlessness on minimal exertion or at rest thought to be related to valve disease. Specialist assessment should include echocardiography to confirm diagnosis and guide management NICE NG208.

Additionally, patients at increased risk of infective endocarditis (such as those with previous infective endocarditis, valve replacement, or certain structural heart diseases) who present with any episodes of infection should be investigated promptly and referred for specialist input to reduce the risk of progression to endocarditis NICE CG64.

In summary, refer suspected infective endocarditis patients urgently to a specialist when:

• There is a new or changing murmur with symptoms or signs of valve disease.
• Severe symptoms such as exertional syncope, angina, or breathlessness are present.
• The patient is at high risk due to underlying cardiac conditions and has signs of infection.

Early specialist assessment including echocardiography is essential for diagnosis and management NICE CG64,NICE NG208.