Endocarditis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overivew

In endocarditis, the white blood cell count and erythrocyte sedimentation rate are elevated. The rheumatoid factor is elevated in half of patients. The BUN and Cr may be elevated in the presence of glomerulonephritis. The EKG can show conduction abnormalities in the presence of a myocardial abscess. The EKG can show ST elevation in the presence of embolization of a vegetation or clot down the coronary artery.

Leukocytosis

A marked leukocytosis is present.

Erythrocyte Sedimentation Rate

An elevated erythrocyte sedimentation rate is present.

Rheumatoid Factor

A positive serum rheumatoid factor may be present and is present in approximately 50% of patients with subacute disease. It becomes negative after successful treatment.

Renal Function

The serum BUN and Cr may be elevated if glomerulonephritis is present.

Urinalysis

Glomerulonephritis may be present.

Electrocardiogram

There is no specific EKG changes that are diagnostic of Infective Endocarditis. The EKG may be useful in the detection of the 10% of patients who develop a conduction delay during Infective Endocarditis by documenting an increased PR interval. If myocardial infarction is present, it may be due to vessel occlusion with ST elevation myocardial infarction or it may be due to distal embolism which may result in non ST elevation MI.

Chest X Ray

There are no specific chest x-ray findings specific for the diagnosis of endocarditis. Non specific findings would include findings of congestive heart failure.

MRI and CT

A CT scan of the head should be obtained in patients who exhibit CNS symptoms or findings consistent with a mass effect (eg, macroabscess of the brain).

Echocardiography

Echocardiography in endocarditis is discussed in its own dedicated chapter.