Infective endocarditis represents a diagnostic and therapeutic challenge, particularly for those unfamiliar with the identification and management of this systemic disease that can express itself in a variety of ways. Certain terms that are still commonly used, especially in developing countries, can be misleading. In this paper, we aim to bring a new perspective to what is called “acute” IE by reviewing the origin of the term and offering a current clinical and echocardiographic approach and practical tools to identify the most severe cases that require timely decisions.