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Doctors begin the diagnosis by taking a history, asking the patient about the symptoms mentioned above. During a physical examination, the doctor may also uncover signs such as fever, an enlarged spleen, signs of kidney disease, or hemorrhaging. Listening to the patient's chest with a stethoscope, the doctor may also hear a heart murmur. A heart murmur may indicate abnormal flow of blood through one of the heart chambers or valves.
Doctors take a sample of the patient's blood to test it for bacteria and other microorganisms that may be causing the infection. They usually also use a test called echocardiography, which uses ultrasound waves to make images of the heart, to check for abnormalities in the structure of the heart wall or valves. One of the telltale signs they look for in echocardiography is vegetation, the abnormal growth of tissue around a valve composed of blood platelets, bacteria, and a clotting protein called fibrin. Another tell-tale sign is regurgitation, or the backward flow of blood, through one of the heart valves. A normal echocardiogram does not exclude the possibility of endocarditis, but an abnormal echocardiogram can confirm its presence. If an echocardiogram cannot be done or its results are inconclusive, a modified technique called transesophageal echocardiography is sometimes performed. Transesophageal echocardiography involves passing an ultrasound device into the esophagus to get a clearer image of the heart.
— Robert Scott Dinsmoor
