Who - Previous heart valve damage, prosthetic valves/cardiac device, congenital heart disorders, previous diagnosis of IE are highest risk factors.
*Don't forget: Poor dentition, HIV, IV drug users, chronic hemodialysis
What - Fever, murmur, cerebral/renal/splenic complications.
Classic IE lesions - Janeway, Osler, Roth spots, splinter hemorrhages - much less common, <10%, but more specific to IE.
ECHO - in search of vegetations
Blood cultures - x3, will help identify 90% organisms
Antibiotics - unasyn and gentamicin for native and prosthetic valve. Vancomycin/daptomycin for suspected IV drug users/MRSA.
CT Surgery - emergent call for hemodynamic compromise