Myocarditis physical examination
Myocarditis physical examination On the Web
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The physical examination in patients with myocarditis may reveal tachycardia, a cardiac gallop, mitral regurgitation due to left ventricular dilation, and pedal edema suggestive of cardiac failure. A pericardial friction rub may be noted in presence of concomitant pericarditis, a condition sometimes referred to as myopericarditis.
- Hypotension (if severe left ventricular systolic dysfunction is present)
- Fever (if an underlying infectious cause is present)
- Jugular venous distension may be noted if the patient has congestive heart failure.
- The apical impulse may be displaced laterally if there is left ventricular dilation.
- S3 or occasionally a summation gallop may be noted, particularly in significant biventricular dysfunction.
- Tachycardia or arrhythmia
- Mitral or tricuspid murmurs (holosystolic murmurs) may also be noted in the presence of significant ventricular dilation leading to regurgitant flow across AV valves.
- Pericardial friction rub and low intensity heart sounds may be evident if pericardium is involved causing pericarditis and effusion respectively.
- The lung fields may be dull on percussion in presence of infection or pleural effusion.
- Basilar crackles may be heard on auscultation, which may be suggestive of pulmonary edema.
- Decreased breath sounds may be noted in presence of an accompanying pleural effusion.
- Egophony may be present if consolidation of the lung is present.
Physical Examination Findings Specific to Various Underlying Causes
- Hypersensitivity/eosinophilic myocarditis: A pruritic maculopapular rash may be present.
- Acute rheumatic fever: Components of the Jones criteria such as erythema marginatum, polyarthralgia, chorea, subcutaneous nodules may be present.