The incidence of endocarditis is between 0.3 and 1.3 episodes per 1000 admissions per year and has been affected by the reduction in rheumatic heart disease, prolonged survival of patients with congenital or degenerative heart disease, and the increase in nosocomial endocarditis. The mitral valve is the most commonly affected, followed by the aortic valve and then the mitral and aortic valves together.

Successful management of this disease requires close co-operation between physician, surgeon, and microbiologist. The intensive care unit (ICU) usually becomes involved in this management just prior to or following surgery to replace an infected valve or when the patient develops a severe complication, for example peripheral, pulmonary, or cerebral embolism or pulmonary edema (Fig 1).

Fig. 1 CT scan of a patient with Staph. aureus endocarditis who was admitted with a stroke. A large cerebral abscess developed to which the patient succumbed.

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