Diagnosis and management of bacterial endocarditis in 2003.

The diagnosis of infective endocarditis has been notoriously difficult. Over the last decade, the modified Duke criteria have assumed an increasingly important role in the early detection of this often occult disease. Echocardiography has assumed increasing importance. Transesophageal echocardiography is recognized as more sensitive and specific than transthoracic echocardiography at detecting vegetations less than 10 mm in diameter. Vegetations greater than 10 mm in diameter are thought to be at increased risk of embolizing. Combined medical and surgical medical management result in the lowest mortality for those patients with hemodynamic compromise.