Infective endocarditis is a pathological entity with numerous problems of diagnosis and medical assistance. Positive blood cultures and echocardiography are indispensable elements in diagnosis and treatment. Transesophageal ultrasound allows accurate localization of lesions according to Carpentier segmentations. Transesophageal echocardiography should be used only in patients with prosthesis or when the transthoracic is inadequate technically or indicates the likelihood of endocarditis. In the case of intermediate and high probability, transthoracic ultrasound should be the procedure to diagnose.