is data to suggest an association between Libman–Sacks endocarditis and a higher risk for embolic cerebrovascular disease in people with systemic lupus erythematosus. Diagnosis Libman–Sacks endocarditis should be considered in instances of thromboembolism in persons with underlying pathology that is associated with LSE. Libman–Sacks endocarditis is diagnosed with echocardiography. Other potential etiologies (e.g. infective endocarditis) should be excluded through an extensive assessment (complete blood count and metabolic panel, blood cultures). Libman–Sacks endocarditis can also be identified post-mortem during an autopsy. Echocardiography Echocardiography is considered the primary evaluation for Libman–Sacks endocarditis; transesophageal echocardiography has greater sensitivity and specificity than transthoracic echocardiography. In case of a negative TTE in the presence of clinical signs of Libman–Sacks endocarditis, transesophageal echocardiography may be attempted to confirm the presence of the condition. Vegetations of the cardiac valves and endocardium are characterised by irregular borders, heterogenous echo density, and an absence of independent motion. Vegetations are usually small, but may be as large as 10mm. The basal and middle portions of the mitral and aortic valves are most commonly involved. Leaflet thickening or regurgitation may be present. There may be other cardiac pathology related to the underlying cause, e.g., lupus. Differential diagnosis Differential diagnoses include: rheumatic valvular disease, atrial myxoma, degenerative valvular disease, infective endocarditis, vasculitis, cholesterol emboli syndrome, fibroelastoma, and Lambl's excrescences. Management/treament The condition should be monitored to follow the development of the vegetations, and health personnel should be conscious of the potential risks associated with the condition. There is a paucity of empirical evidence on treatment options for persons with Libman–Sacks endocarditis, and treatment should focus on the underlying cause. Anticoagulant treatment is recommended in cases with previous thromboembolic event for prevention of subsequent occurrences. Surgical intervention may be indicated in case of significant valvular dysfunction. Prognosis Libman–Sacks endocarditis is often associated with considerable morbidity and mortality. Epidemiology Libman–Sacks endocarditis has been observed in 0.2% in of the general population at autopsy. It occurs most commonly in those aged 40 to 80 years. Libman–Sacks endocarditis vegetations are observed in 10% of systemic lupus erythematosus cases (however, in one study, vegetations were noted in 43% of systemic lupus erythematosus cases (0% in controls), and valvular thickening in 51% of systemic lupus erythematosus cases (7% in controls)). There is a significant correlation between systemic lupus erythematosus duration and severity, and the incidence of Libman–Sacks endocarditis. Libman–Sacks endocarditis has been identified in 1.25% of those with