Infectious endocarditis is a highly morbid disease with approximately 43,000 cases per year in the United States. The modified Duke Criteria have poor sensitivity, however advances in diagnostic imaging provide new tools for clinicians to make this at times elusive diagnosis. There are a number of risk stratification calculators which can help guide providers in medical and surgical management. Patients who inject drugs pose unique challenges for the health care system as their addiction, which is often untreated, can lead to recurrent infections after valve replacement.