Myocarditis physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{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) | ||
* | |||
=== | ===Skin=== | ||
* Skin examination of patients with [disease name] is usually normal. | |||
* | |||
OR | OR | ||
*[[Cyanosis]] | |||
*[[Cyanosis]] | |||
*[[Jaundice]] | *[[Jaundice]] | ||
* [[Pallor]] | *[[Pallor]] | ||
* Bruises | * Bruises | ||
< | <br /> | ||
===HEENT=== | |||
* HEENT examination of patients with [disease name] is usually normal. | |||
* | |||
* | |||
* 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=== | ||
* | |||
*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. | |||
* | |||
* | |||
*[[ | |||
* | |||
===Heart=== | ===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|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. | |||
*[[ | |||
*[[ | |||
===Abdomen=== | ===Abdomen=== | ||
* [[Ascites]] may be observed if [[heart failure]] and fluid overload is present. | |||
* | |||
===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=== | ||
* | [[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 | ||
The presence of [finding(s)] on physical examination is highly suggestive of [disease name]. | |||
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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
- Hypotension (if severe left ventricular systolic dysfunction is present)
- Tachycardia
- Tachypnea
- Fever (if an underlying infectious cause is present)
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
- Jugular venous distension
- Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
- Lymphadenopathy (describe location, size, tenderness, mobility, and symmetry)
- Thyromegaly / thyroid nodules
- Hepatojugular reflux
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.
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.
Abdomen
- Ascites may be observed if heart failure and fluid overload is present.
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
- 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.[1]
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
- ↑ 1.0 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=
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