Table 8. Approach to the patient with suspected endocarditis.

Recommendations	Timing
Determination of patient’s hemodynamic status and decision for place of hospitalization accordingly	Immediately
Prediction of prognosis according to simplified risk score and referral of the patients with a score of ≥8 to the reference centre	In the first 24 hours or after getting the results of blood cultures and weekly
TTE	Immediately
TEE When TTE is of suboptimal quality or complications are suspected Other conditions	Immediately In the first 48 hours
Whole blood count, serum CRP, ESR, procalcitonin, BUN, creatinine, urine analysis, ALT, AST, glucose, NT-pro-BNP and cTnI levels	Immediately
Three-sets of blood cultures	Within the first hour (at 0., 30th and 60th minutes)
Collection of blood samples in to three plain tubes and 1 EDTA tube  •   Sending of the first plain tube of blood to the laboratory for RF, ANA and Wright agglutination testing •   Sending of the second plain tube of blood to the laboratory for Coxiella burnetii phase I IgG testing •   Sending of third plain tube and first EDTA tube of blood to the laboratory for multiplex and specific PCR testing and other serological antibody testing	In the first 24 hours In the case of blood cultures negativity In the case of blood cultures negativity
ECG	Immediately
Repeating blood cultures in patients with a history of antibiotic usage in the previous 10 days and stable general condition	72 hours after discontinuation of antibiotics
Fundoscopic examination	In the first 48 hours
Classification of the diagnosis according to Modified Duke Criteria	In the first 5 days
Abdominal USG	In the case of persistent fever and searching for a minor Duke criterion In the first 7 days
Cardiac CT, MRI, 18F-FDG PET/CT, SPECT/CT with scintigraphy with labelled leukocyte	In patients with inconclusive echocardiographic results and suspected IE In the first 7 days
TTE: Transesophageal echocardiography; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; BUN: Blood urea nitrogen; ALT: Alanine aminotransferease; AST: Aspartate aminotransferase; NT-pro-BNP: NT-pro B-type natriuretic peptide; cTnI: Cardiac troponin I; EDTA: Ethylene-diamine-tetra acetic acid; ANA: Antinuclear antibody; PCR: Polymerase chain reaction; ECG: Electrocardiogram; USG: Ultrasonography; CT: Computed tomography; MRI: Magnetic resonance imaging; 18F-FDG: 18F-Fluorodeoxyglucose; PET: Positron emission tomography; SPECT: Single-photon emission computed tomography.