Infective endocarditis (IE) is a potentially fatal disease. Although pathological examination is the gold standard for the diagnosis of IE, only a small number of patients undergo this examination. The clinical diagnosis of IE still mainly relies on its clinical symptoms. However, the systemic manifestations of IE are diverse and often non-cardiac specific, which poses a great challenge to diagnosis. Based on the clinical presentations, imaging characteristics, and etiological data of IE, experts at home and abroad have developed a variety of diagnostic tools. Over the past thirty years, there have been significant changes in the microbiological and epidemiological characteristics of IE, and at the same time, the advancement of imaging and laboratory diagnostic technologies has also had an important impact on diagnostic methods, leading to the continuous evolution of diagnostic criteria and tools. This article reviews and interprets the main diagnostic criteria for IE, analyzes its development history, current changes, and efficacy, aiming to provide a perspective on the historical evolution of diagnostic tools and to offer prospects for future research directions.