Myocarditis physical examination: Difference between revisions

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__NOTOC__
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{{Myocarditis}}
 
{{CMG}} {{AE}} [[Varun Kumar]] M.B.B.S., {{Maliha}}{{Homa}}
{{CMG}} {{AE}} [[Varun Kumar]] M.B.B.S., {{Maliha}}{{Homa}}


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*[[Tachypnea]]
*[[Tachypnea]]
*[[Fever]] (if an underlying infectious cause is present)
*[[Fever]] (if an underlying infectious cause is present)
*


===Heart===
===Skin===
*[[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|S<sub>3</sub>]] or occasionally a [[summation gallop]] may be noted, particularly in significant biventricular dysfunction.
**[[Tachycardia]] or [[arrhythmia]]
**Mitral or tricuspid murmurs ([[holosystolic murmur]]s) 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 [[pericardial effusion|effusion]] respectively.


===Lungs===
* Skin examination of patients with [disease name] is usually normal.
*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.<ref name="pmid16476862">{{cite journal| author=Magnani JW, Dec GW| title=Myocarditis: current trends in diagnosis and treatment. | journal=Circulation | year= 2006 | volume= 113 | issue= 6 | pages= 876-90 | pmid=16476862 | doi=10.1161/CIRCULATIONAHA.105.584532 | pmc= |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16476862  }} </ref>
 
 
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].


OR
OR


The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*[[Cyanosis]]
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
 
OR
 
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].
 
===Vital Signs===
 
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
 
===Skin===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]  
*[[Jaundice]]
*[[Jaundice]]
* [[Pallor]]
*[[Pallor]]
* Bruises
* Bruises


<gallery widths="150px">
<br />
===HEENT===


UploadedImage-01.jpg | Description {{dermref}}
* HEENT examination of patients with [disease name] is usually normal.
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
*  
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


<br />
===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with [disease name] is usually normal.
OR
OR
*[[Jugular venous distension]]
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
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===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
 
OR
*The lung fields may be dull on [[percussion]] in presence of [[infection]] or [[pleural effusion]].
* Asymmetric chest expansion OR decreased chest expansion
*[[Basilar crackles]] may be heard on [[auscultation]], which may be suggestive of [[pulmonary edema]].
*Lungs are hyporesonant OR hyperresonant
*[[Decreased breath sounds]] may be noted in presence of an accompanying [[pleural effusion]].
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*[[Egophony]] may be present if consolidation of the lung is present.
*Rhonchi
 
*Vesicular breath sounds OR distant breath sounds
*
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
*[[Jugular venous distension]] may be noted if the patient has [[congestive heart failure]].
OR
*The [[apical impulse]] may be displaced laterally if there is [[left ventricular dilation]].
*Chest tenderness upon palpation
*Auscultation:
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
**[[S3|S<sub>3</sub>]] or occasionally a [[summation gallop]] may be noted, particularly in significant biventricular dysfunction.
*[[Heave]] / [[thrill]]
**[[Tachycardia]] or [[arrhythmia]]
*[[Friction rub]]
**Mitral or tricuspid murmurs ([[holosystolic murmur]]s) may also be noted in the presence of significant ventricular dilation leading to regurgitant flow across AV valves.
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
**[[Pericardial friction rub]] and low intensity [[heart sounds]] may be evident if [[pericardium]] is involved causing [[pericarditis]] and [[pericardial effusion|effusion]] respectively.
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope


===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
OR
*[[Abdominal distension]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
* [[Ascites]] may be observed if [[heart failure]] and fluid overload is present.
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with [disease name] is usually normal.
OR
OR
*A pelvic/adnexal mass may be palpated
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Inflamed mucosa
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===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
OR
*Patient is usually oriented to persons, place, and time
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Altered mental status
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*Normal finger-to-nose test / Dysmetria
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
*Absent/present dysdiadochokinesia (palm tapping test)
*


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
[[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.<ref name="pmid16476862">{{cite journal| author=Magnani JW, Dec GW| title=Myocarditis: current trends in diagnosis and treatment. | journal=Circulation | year= 2006 | volume= 113 | issue= 6 | pages= 876-90 | pmid=16476862 | doi=10.1161/CIRCULATIONAHA.105.584532 | pmc= |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16476862  }} </ref>
 
 
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
 
OR
 
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
OR
*[[Clubbing]]
 
*[[Cyanosis]]
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
*Pitting/non-pitting [[edema]] of the upper/lower extremities
 
*Muscle atrophy
*Fasciculations in the upper/lower extremity




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[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Up-To-Date]]​
[[Category:Up-To-Date]]
[[Category:Primary care]]
[[Category:Primary care]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]

Revision as of 22:20, 14 January 2020


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] Homa Najafi, M.D.[3]

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.[1]

Vital signs

Skin

  • Skin examination of patients with [disease name] is usually normal.

OR


HEENT

  • HEENT examination of patients with [disease name] is usually normal.
  • Facial tenderness
  • Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


Neck

  • Neck examination of patients with [disease name] is usually normal.

OR

Lungs

Heart

Abdomen

Genitourinary

  • Genitourinary examination of patients with [disease name] is usually normal.

OR

  • A pelvic/adnexal mass may be palpated
  • Inflamed mucosa
  • Clear/(color), foul-smelling/odorless penile/vaginal discharge

Neuromuscular

  • Neuromuscular examination of patients with [disease name] is usually normal.

OR

  • Patient is usually oriented to persons, place, and time
  • Altered mental status
  • Glasgow coma scale is ___ / 15
  • Clonus may be present
  • Hyperreflexia / hyporeflexia / areflexia
  • Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
  • Muscle rigidity
  • Proximal/distal muscle weakness unilaterally/bilaterally
  • ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
  • Unilateral/bilateral upper/lower extremity weakness
  • Unilateral/bilateral sensory loss in the upper/lower extremity
  • Positive straight leg raise test
  • Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
  • Positive/negative Trendelenburg sign
  • Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
  • Normal finger-to-nose test / Dysmetria
  • Absent/present dysdiadochokinesia (palm tapping test)

Extremities

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

Physical Examination Findings Specific to Various Underlying Causes


Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

Physical examination of patients with [disease name] is usually normal.

OR

Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


References

  1. ↑ 1.0 1.1 Magnani JW, Dec GW (2006). "Myocarditis: current trends in diagnosis and treatment". Circulation. 113 (6): 876–90. doi:10.1161/CIRCULATIONAHA.105.584532. PMID 16476862. Unknown parameter |http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom= ignored (help)

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