Acute infective endocarditis are due to highly virulent microorganisms, such as Staphylococcus aureus, able to invade normal endocardium, causing fulminant local damages (valvular destruction) as well as general damages (sepsis, metastasis), so that clinical manifestations are usually dramatic. Empirical antimicrobial therapy must be given immediately, using combinations active against the most commonly encountered pathogens. Other treatments are frequently necessary: medical therapy for heart failure, surgery of valvular reconstruction or replacement, respiratory assistance and other supportive measures. Such management requires cooperation of several disciplines.