Tiny Tips: Infective Endocarditis FROM JANE

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Infective endocarditis refers to an infection (i.e., bacteria such as Strep, Staph or fungal) that seeds onto the endocardial surface of valves.​1​ The mortality rate of endocarditis is 25%.​2​ Systemic complications include septic embolization and can result in end-organ damage. Although native heart valves are the most commonly affected, prosthetic heart valves, heart valve disease, congenital heart disease, previous history of endocarditis and IV drug use are risk factors for endocarditis and easy to screen for.

In patients presenting to the ER with a fever and unknown source of infection, endocarditis should be on the differential. Use the acronym FROM JANE to help identify the clinical manifestations of endocarditis.

F: Fever

R: Roth spots (retinal hemorrhages with pale centres)

O: Osler nodes (tips of fingers and toes, painful)

M: Murmur (cardiac)

J: Janeway lesions (palms and soles, painless)

A: Anemia

N: Nail hemorrhage (i.e., splinter hemorrhages)

E: Emboli

This post was copyedited by @aafia-maqsood and edited by Daniel Ting.


  1. 1.
    Chu V, Wang A. Clinical manifestations and evaluation of adults with suspected left-sided native valve endocarditis. . Uptodate. Published 2022. Accessed May 29, 2023. https://www.uptodate.com/contents/clinical-manifestations-and-evaluation-of-adults-with-suspected-left-sided-native-valve-endocarditis?search=endocarditis%20diagnosis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
  2. 2.
    Ambrosioni J, Hernandez-Meneses M, et al. The Changing Epidemiology of Infective Endocarditis in the Twenty-First Century. Curr Infect Dis Rep. Published online April 12, 2017. doi:10.1007/s11908-017-0574-9

Reviewing with the staff

Early diagnosis of Endocarditis is vital for our patients. Being mindful of these clinical features will help clinicians to diagnose this hazardous infection early. This will prevent the inevitable progression of end-organ damage that occurs with this disease. Complications like stroke and infarcts of the kidney and spleen cause irreversible damage while ongoing endocarditis can worsen heart valve damage and increase the number of septic emboli sprayed all through the body. Remember, we cannot diagnose conditions we are not mindful of. In light of that, this mnemonic should be committed to memory.

Hanzla Tariq
Full-Time Emergency Physician at the Brampton Civic Hospital Associate Clinical Professor with McMaster University Special interest in Simulation-Based education. No conflicts of interest.

Jasdeep Saggar

Jasdeep Saggar is a second year Family Medicine Resident at McMaster University. She has a particular interest in ER medicine and medical education and serves as the educational liaison between residents and faculty. In her spare time, she enjoys salsa dancing and traveling.

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