Symptoms of endocarditis may develop slowly (subacute) or suddenly (acute). Fever is the classic symptom and may persist for days before any other symptoms appear.

Other symptoms may include:

• Abnormal urine color
• Blood in the urine
• Chills
• Excessive sweating
• Fatigue
• Joint pain
• Muscle aches and pains
• Nail abnormalities (splinter hemorrhages under the nails)
• Night sweats (may be severe)
• Paleness
• Red, painless skin spots on the palms and soles (Janeway lesions)
• Red, painful nodes (Osler's nodes) in the pads of the fingers and toes
• Shortness of breath with activity
• Swelling of feet, legs, abdomen
• Weakness
• Weight loss

The health care provider may hear abnormal sounds, called murmurs, when listening to your heart with a stethoscope.

A physical exam may also reveal:

• Enlarged spleen
• Splinter hemorrhages in the fingernails

A history of congenital heart disease raises the level of suspicion. An eye exam may show bleeding in the retina a central area of clearing. This is known as Roth's spots.

The following tests may be performed:

• Blood culture and sensitivity (to detect bacteria)
• Chest x-ray
• Complete blood count (may show mild anemia)
• CT scan of the chest
• Echocardiogram (ultrasound of the heart)
• Erythrocyte sedimentation rate (ESR)
• Transesophageal echocardiogram