Myocarditis physical examination

Myocarditis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology Adrenergic Myocarditis Giant Cell Myocarditis
Causes
Differentiating Myocarditis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Myocarditis physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Google Images
American Roentgen Ray Society Images of Myocarditis physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Myocarditis physical examination
CDC on Myocarditis physical examination
Myocarditis physical examination in the news
Blogs on Myocarditis physical examination
Directions to Hospitals Treating Type page name here
Risk calculators and risk factors for Myocarditis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Varun Kumar M.B.B.S., Maliha Shakil, M.D. [2]

Overview

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.

Physical Examination

General appearance

Patients with mild cases of myocarditis may have a non-toxic appearance. Patients with acute onset or advanced disease may present with signs of cardiac dysfunction.

Vital signs

• Hypotension (if severe left ventricular systolic dysfunction is present)
• Tachycardia
• Tachypnea
• Fever (if an underlying infectious cause is present)

Heart

• 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.
• Auscultation:
  • 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.

Lungs

• 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.

Abdomen

Ascites may be observed if heart failure and fluid overload is present.

Extremities

Pedal edema may be observed if congestive heart failure and fluid overload are 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.