**1. Introduction**

Endocarditis is defined as inflammation of the inner layer of the endocardium, usually involving the heart valves and or chambers of the heart, the valves being more commonly affected than the heart chambers [1]. Endocarditis is further categorized into non-bacterial thrombotic endocarditis (NBTE) or noninfectious endocarditis, and infectious endocarditis (IE) [2]. NBTE is rare and associated with malignancy and chronic inflammatory states such as systemic lupus erythematosus, rheumatoid arthritis, ANCA-vasculitis, burns, and sepsis [2, 3]. Conversely, IE is more common, with annual incidence of 3–10 cases per 100,000 people [4, 5]. It occurs due to bacterial and less commonly due to fungal infections [1, 4, 5]. *Staphylococcus aureus* is now the leading cause of IE, accounting for about 26.6% of all cases [4]. Staphylococci, streptococci (including the viridans group) and enterococci comprise about 80–90% of all cases of IE [4, 5]. The other 10–20% of cases are due culture negative endocarditis and fastidious organisms such bartonella species, brucella species, *Coxiella burnetii*, haemophilus species, *Aggregatibacter actinomycetenomitans*, *Cardiobacterium hominis*, *Eikenella corrodens*, *Kingella kingae*

and *Tropheryma whipplei* [5]. Endocarditis is characterized by lesions, known as vegetations. These vegetations follow endocardial injury where platelets and fibrin form a nidus which becomes secondarily infected by microorganisms circulating in the blood. (1) Endocarditis can involve both the right and left side of the heart and often can have differing causative organisms and etiologies. Left sided endocarditis can involve the aortic valve, mitral valve and in severe cases can involve the aortomitral curtain causing damage to the electrical structures of the heart. Right sided endocarditis typically involves the valvular structures on the right side of the heart most commonly the tricuspid valve and less often the pulmonary valve. In addition, the right sided endocarditis may also involve foreign bodies that are typically found transversing the right atrium such as pacemaker leads, central lines.
