Admit all suspected cases and consult Cardiothoracic surgery for<unk>  complicated by:
New Heart failure suspected due to severe regurgitation
Cardiogenic Shock
Echocardiography demonstrating a new fistula
Surgery indicated for:
Acute heart failure
Periannular extension
Recurrent emboli
Large mobile vegetations
Persistent bacteremia
Fungal<unk>  (penetration of antifungals into vegetation walls poor)
IV amphotericin B
Lifelong PO antifungal
Acute heart failure
Periannular extension
Recurrent emboli
Large mobile vegetations
Persistent bacteremia
Fungal<unk>  (penetration of antifungals into vegetation walls poor)
IV amphotericin B
Lifelong PO antifungal
IV amphotericin B
Lifelong PO antifungal
Endocarditis
Critical
Myocarditis
Sepsis
Myocarditis 
PNA with respiratory failure
Constrictive pericarditis
Peritonitis