Summary: Infective endocarditis (IE) may present a unique diagnostic and therapeutic challenge, especially in elderly patients with atypical clinical presentation of infection, delayed diagnosis and poor outcome. New guidelines from the European Society of Cardiology on the management of IE have now been published. The article presents the basic principles of recognition, diagnosis, treatment and prevention of IE included in the guidelines, with particular emphasis on problems affecting elderly patients. To highlight the difficulties in the diagnosis and treatment of IE in older people, three cases of IE with different clinical presentations are presented.