The clinical manifestations of IE result from
- the local destructive effects of intracardiac infection;
- the embolization of bland or septic fragments of vegetations to distant sites, resulting in infarction or infection;
- the hematogenous seeding of remote sites during continuous bacteremia; and
- an antibody response to the infecting organism with subsequent tissue injury due to deposition preformed immune complexes or antibody complement interaction with antigens deposited in tissues.