Clinical features

• fever 
• rigors
• a new or changed heart murmur 
• complications 
  • neurological involvement (headache, mental state changes)
  • emboli: strokes, petechiae (including palettal, Janeway lesions, conjunctival haemorrhages, Roth spots)
  • evidence of heart failure or dyspnoea
  • hepatomegaly
  • splenomegaly

Note:

Splinter haemorrhages are not very helpful in diagnosing infective endocarditis. 

Why?

• Splinter haemorrhages are common (occuring in 10% of medical patients) ^c
• No patients with splinter haemorrhages in one study had infective endocarditis. ^c

Fever, rigors and new or changed heart murmurs are common in infective endocarditis

Clinical features c	sensitivity
fever	94% to 100%
rigors	68%
heart murmur	68%
new or changed murmur	39% to 47%
no murmur	24%
heart failure	44%
dypnoea	39% to 44%
CNS emboli	24% to 33%
skin infection	27%
petechiae, splinters, Janeway lesions	8% to 27%
splinter haemorrhages	8%
hepatomegaly	20%
splenomegaly	3% to 15%
conjunctival haemorrhages	3%