My common diagnosis is heart failure, and my less-common diagnosis is endocarditis. Working in critical care, I’ve seen a lot of heart failure exacerbations but have yet to see endocarditis. Signs and symptoms of heart failure (HF) include dyspnea on exertion or rest, orthopnea, and edema.

My common diagnosis is heart failure, and my less-common diagnosis is endocarditis. Working in critical care, I’ve seen a lot of heart failure exacerbations but have yet to see endocarditis. Signs and symptoms of heart failure (HF) include dyspnea on exertion or rest, orthopnea, and edema.

The patient could also experience weight-gain secondary to fluid retention, bibasilar crackles on auscultation, tachycardia, and hypoxia (Grubbs & Davis, 2019). With endocarditis, the health care provider (HCP) would find signs and symptoms indicative of a systemic infection, such as fevers, chills, arthralgias, malaise, and fevers (Grubbs & Davis, 2019).

As the infection progresses, the patient will develop petechiae, anemia, weight loss, a new or worsening heart murmur, and emboli (Grubbs & Davis, 2019). A detailed history and physical (H&P) are required for both diagnoses.

The H&P for HF requires the HCP to obtain a detailed account of underlying medical conditions and functional capacity to exercise (Malik et al., 2022). For endocarditis, the HCP would get a thorough history of any infectious process and note skin changes, such as petechiae. Upon auscultation, the HCP would hear new heart sounds (Gupta & Mendez, 2022).

For diagnosis, there are overlapping studies like a chest x-ray (CXR) and echocardiogram. If there is a strong suspicion of endocarditis, a transesophageal echocardiogram (TEE) would be recommended, along with blood cultures (Gupta & Mendez, 2022).

The purpose of the TEE vs. a transthoracic echocardiogram (TTE) is that the images will be more precise with the TEE due to the proximity to the heart. Positive blood cultures and a positive echocardiogram are required to diagnose endocarditis.

For HF, a CXR, echocardiogram, CBC, BNP, CMP, and cardiac catheterization are recommended (Grubbs & Davis, 2019). Interpreting the H&P, imaging, and lab results will assist the HCP in a proper differential diagnosis.

References

• Grubbs, L., & Davis, L. L. (2019). Cardiac and peripheral vascular systems. In M. J. Goolsby & L. Grubbs (Eds.), Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses (4th ed., pp. 187–234). F.A. Davis.
  Gupta, A., & Mendez, M. D. (2022). Endocarditis. In StatPearls. StatPearls Publishing. http //www.ncbi.nlm.nih.gov/books/NBK499844/
  Links to an external site.
• Malik, A., Brito, D., Vaqar, S., & Chhabra, L. (2022). Congestive Heart Failure. In StatPearls. StatPearls Publishing. http //www.ncbi.nlm.nih.gov/books/NBK430873/