Blood culture (from 3 separate sites)
CBC
Staphylococcal<unk> : Leukocytosis +/- thrombocytopenia
Subacute<unk> : WBC may be normal or elevated
Urinalysis
Hematuria
ESR
Elevated in >90% of cases
ECG
Ischemia, heart block
CXR
Pulmonary emboli, CHF
Ultrasound
Obtain as soon as possible
TEE may be required for:
Prosthetic valves
Difficulty obtaining clear TTE images (obesity, COPD)
High clinical probability of<unk> 
Staphylococcal<unk> : Leukocytosis +/- thrombocytopenia
Subacute<unk> : WBC may be normal or elevated
Hematuria
Elevated in >90% of cases
Ischemia, heart block
Pulmonary emboli, CHF
Obtain as soon as possible
TEE may be required for:
Prosthetic valves
Difficulty obtaining clear TTE images (obesity, COPD)
High clinical probability of<unk> 
Prosthetic valves
Difficulty obtaining clear TTE images (obesity, COPD)
High clinical probability of<unk> 
Inpatient diagnosis is based on the Duke's Criteria although many of the criteria are not filled in the ED
Heightened clinical suspicion is necessary even if diagnosis does not meet the official criteria.
Heightened clinical suspicion is necessary even if diagnosis does not meet the official criteria.
2 major criteria OR
1 major and 3 minor criteria OR
5 minor criteria
Positive blood culture with typical IE microorganism, defined as one of the following:
Typical microorganism consistent with IE from 2 separate blood cultures, as noted below:
Viridans-group streptococci, or
Streptococcus bovis including nutritional variant strains, or
HACEK group, or
Staphylococcus aureus, or
Community-acquired Enterococci, in the absence of a primary focus
Microorganisms consistent with IE from persistently positive blood cultures defined as:
Two positive cultures of blood samples drawn >12 hours apart, or
All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)
Coxiella burnetii detected by one positive blood culture or IgG
Staphylococus lugdunensis should raise concerns for<unk>  with a single positive blood culture
Evidence of endocardial involvement with positive echocardiogram defined as:
Valvular mass or supporting structures or
Abscess, or
New disruption of a prosthetic valve or new valvular regurgitation
Typical microorganism consistent with IE from 2 separate blood cultures, as noted below:
Viridans-group streptococci, or
Streptococcus bovis including nutritional variant strains, or
HACEK group, or
Staphylococcus aureus, or
Community-acquired Enterococci, in the absence of a primary focus
Microorganisms consistent with IE from persistently positive blood cultures defined as:
Two positive cultures of blood samples drawn >12 hours apart, or
All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)
Coxiella burnetii detected by one positive blood culture or IgG
Staphylococus lugdunensis should raise concerns for<unk>  with a single positive blood culture
Viridans-group streptococci, or
Streptococcus bovis including nutritional variant strains, or
HACEK group, or
Staphylococcus aureus, or
Community-acquired Enterococci, in the absence of a primary focus
Two positive cultures of blood samples drawn >12 hours apart, or
All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)
Coxiella burnetii detected by one positive blood culture or IgG
Staphylococus lugdunensis should raise concerns for<unk>  with a single positive blood culture
Valvular mass or supporting structures or
Abscess, or
New disruption of a prosthetic valve or new valvular regurgitation
Predisposing factor: known cardiac lesion, recreational drug injection
Fever >38°C
Evidence of emboli: arterial emboli,pulmonary infarcts, Janeway lesions, conjunctival hemorrhage
Glomerulonephritis, Osler's nodes
Positive blood culture (that does not meet a major criterion) or serologic evidence of infection
Endocarditis
Critical
Myocarditis
Sepsis
Myocarditis 
PNA with respiratory failure
Constrictive pericarditis
Peritonitis