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Could Cardiac POCUS Help Diagnose Infective Endocarditis Earlier?

  • Jul 8
  • 2 min read

Dr Jonathan Henry et al

FACEM, GDipClinUS (University of Melbourne), CCPU (ASUM)

Twitter: @DrJonoHenry @EmergencyEcho


One of EMUGs own contributors Dr Jono Henry recently had this article published in the Australasian Journal of Ultrasound in Medicine. We would like to extend our congratulations on the publication of this article to all co-authors including EMUGs stalwart Dr Allan Whitehead.


Infective endocarditis (IE) is one of emergency medicine's most challenging diagnoses. Its symptoms are often vague, patients can deteriorate rapidly, and delays in diagnosis are associated with increased complications and mortality.

A newly published Australasian case series highlights the growing role that cardiac point-of-care ultrasound (POCUS) may play in identifying this life-threatening condition at the bedside.


The study reviewed 19 cases of infective endocarditis diagnosed by emergency physicians using cardiac POCUS across Australia and New Zealand. Every patient went on to have the diagnosis confirmed with comprehensive echocardiography, demonstrating that emergency physicians are increasingly recognising obvious valvular vegetations during their initial assessment.


One of the most striking findings was how unreliable the "classic" clinical features proved to be. Less than half of patients had a documented cardiac murmur, and only around one-third recorded a temperature above 38°C while in the emergency department. Yet almost 80% had already developed embolic complications, highlighting just how advanced disease can become before diagnosis is made.


The authors aren't suggesting that cardiac POCUS should replace formal echocardiography. Instead, they argue that it should become another valuable decision-making tool when clinical suspicion is high—particularly when access to comprehensive echocardiography or transoesophageal echocardiography (TOE) is delayed.

Importantly, the paper also reinforces a principle familiar to many POCUS users: the sickest patients often have the most obvious findings. Larger vegetations are associated with worse outcomes and are also more likely to be detected with transthoracic imaging, making bedside ultrasound particularly valuable in patients with significant clinical suspicion.


While this was a case series not a diagnostic accuracy study, it provides encouraging evidence that advanced cardiac POCUS skills are continuing to evolve within emergency medicine. The authors conclude that further research is now needed to determine the sensitivity and specificity of emergency physician-performed cardiac POCUS for detecting infective endocarditis and to better define its role in clinical practice.


For clinicians, the message is clear: when infective endocarditis is on your differential, cardiac POCUS may help identify critical findings earlier, expedite definitive imaging, and ultimately shorten the time to life-saving treatment.



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