While uncommon, infective endocarditis can result in significant patient morbidity and mortality. A multidisciplinary treatment plan is best given the need for long-term antibiotics, medical management for symptom mitigation, and surgical planning for symptom resolution. Early surgical intervention can be key in certain cases of infective endocarditis, particularly in the setting of infection refractory to antibiotic therapy, resultant heart failure, abscess formation, and large vegetative lesions at risk for embolization. The modified Duke criteria is commonly used in the diagnosis of endocarditis. Echocardiography can play a major diagnostic role as part of this criteria. Direct echocardiographic findings consistent with endocarditis include vegetations, abscesses, and other perivalvular complications, and new dehiscence of a prosthetic valve if one is present. Transthoracic echocardiographic (TTE) imaging is often used initially for cardiac evaluation given its non-invasive nature but is less diagnostically sensitive than transesophageal imaging (TEE), particularly in patients with prosthetic valves. Normal anatomic variants can be confused for vegetations, further reinforcing the need for echocardiographic familiarity and expertise when using this diagnostic modality as a major criterion. Endocarditis can affect both the left and/or right sides of the heart, resulting in the need for unique management and surgical considerations. Factors to consider include the laterality of the infection, lesion location and size, surrounding tissue involvement, and resultant signs and symptoms. Prosthetic valve endocarditis can be challenging to diagnose. It has a worse prognosis than native valve endocarditis and requires aggressive treatment with early surgical intervention when appropriate.