What is the recommended protocol for echocardiography in the diagnosis and management of patients with infective endocarditis (IE)?
Echocardiography is central to the diagnosis and management of patients with IE. It is recommended that Trans-Thorasic Echocardiography (TTE) should be done initially in all cases of suspected IE, and if any circumstances preclude the securing of optimal echocardiographic windows, then Trans-Esophageal Echocardiography (TEE) should be performed as soon as possible after TTE. If TTE shows vegetations but the likelihood of complications is low, then subsequent TEE is unlikely to alter initial medical management. On the other hand, if clinical suspicion of IE or its complications is high, then a negative TTE will not definitely rule out IE or its potential complications, and TEE should be performed first. 