Endocarditis refers to endothelial damage with thrombosis on endocardial surfaces, typically on the heart valves (see the image below). Two major types of endocarditis exist: infectious endocarditis, which has a microbial etiology, and noninfectious endocarditis. Several terms have been used for these conditions, including (subacute) bacterial endocarditis for infectious endocarditis, and nonbacterial thrombotic endocarditis (NBTE) or marantic endocarditis for noninfectious endocarditis. The classic signs of Osler nodes and Janeway lesions are increasingly uncommon, but microembolic phenomena such as splinter hemorrhages, Roth spots, and glomerulonephritis are still frequently observed in patients in the 21st century. Endocarditis occurs when germs enter your bloodstream, travel to your heart, and attach to abnormal heart valves or damaged heart tissue. Bacteria cause most cases, but fungi or other microorganisms also may be responsible.