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.