Infective endocarditis (IE) is a serious disease involving the inner layer of the heart, particularly of the valves. Even in the modern era of advanced diagnostic imaging, improved antimicrobial chemotherapy and potentially curative surgery, IE is associated with a persistently high morbidity and mortality. With increasing number of patients with congenital heart disease surviving into adulthood, growing population of elderly with degenerative valve diseases, liberal use of intravascular devices, ever rising nosocomial infections and markedly expanding number of immunosuppressed individuals, IE continues to be a major health issue. The first part of this chapter reviews the evolution of endocarditis over the years and the later part deals with current trends and emerging issues.