Infective endocarditis is an infection of the endocardial surface of the heart, most often a valve. It is uncommon, it is frequently missed early, and untreated it is close to uniformly fatal — which is why a patient with unexplained fever and a reason to have a susceptible heart deserves active suspicion rather than reassurance. What makes it distinctive is that it is an *endovascular* infection. The organism is not walled off in a tissue abscess; it is sitting on a surface washed by every liter of blood the heart moves. That single fact explains almost everything else about the disease: the persistent bacteremia, the need for prolonged intravenous therapy, the fever that does not settle, and the sudden catastrophic complications when a fragment breaks free. This lesson is written for United States pediatric primary care nurse practitioner practice. Endocarditis in children is uncommon, and when it occurs it is overwhelmingly a disease of children with congenital heart disease or prosthetic material — which means the risk is usually known in advance. The specialty task is recognizing it in a...