Abstract
Infective endocarditis can be a challenging and potentially life-threatening diagnosis in the emergency department (ED) due to its often nonspecific presentation. Missed or delayed recognition can result in serious complications. Point-of-care ultrasound (POCUS) is increasingly utilized in emergency medicine to expedite the diagnosis of critical conditions, including endocarditis. We present a case series of four patients who presented to the ED with varied chief complaints - altered mental status, fever with shortness of breath, delirium, and isolated extremity pain. In each case, emergency physicians identified valvular vegetations using POCUS, prompting expedited consultation and management. Each case involved a different cardiac valve, with representative images and video clips provided. We outline our bedside approach and highlight key sonographic findings to aid in the early identification of infective endocarditis. Emergency physicians are increasingly equipped to identify life-threatening pathology with bedside imaging. These cases underscore how POCUS can aid in the early diagnosis of infective endocarditis, especially when presentations are atypical. Rapid identification can lead to earlier initiation of antibiotics, targeted diagnostic workups, and specialist involvement, leading to improved patient outcomes.