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==Overview== | ==Overview== | ||
Myocarditis should be suspected in a [[patient]] with [[acute]] [[decompensation]] of [[Cardiac function curve|cardiac function]] who is at low risk of [[ischemic heart disease]]. A [[History and Physical examination|history]] of a recent (within the preceding 2-4 weeks) [[viral]] [[illness]] is often elicited in a large number of [[patients]] with myocarditis. [[Cardiac]] specific [[symptoms]] may become apparent usually in the [[subacute]] [[virus]]-clearing phase. In myocarditis due to [[drug hypersensitivity]], [[patients]] may give a [[History and Physical examination|history]] of ingesting an offending [[drug]]. In [[fulminant]] myocarditis, [[patients]] present with the abrupt onset of [[flu]]-like [[symptoms]] and the abrupt onset of [[heart failure]] [[symptoms]]. In [[chronic]] and [[acute]] myocarditis, the onset of [[symptoms]] may be more insidious. Common symptoms of myocarditis include [[chest pain]], [[pedal edema]], [[palpitation]]s, [[fever]], and [[joint pain]]s. | Myocarditis should be suspected in a [[patient]] with [[acute]] [[decompensation]] of [[Cardiac function curve|cardiac function]] who is at low risk of [[ischemic heart disease]]. A [[History and Physical examination|history]] of a recent (within the preceding 2-4 weeks) [[viral]] [[illness]] is often elicited in a large [[number]] of [[patients]] with myocarditis. [[Cardiac]] specific [[symptoms]] may become apparent usually in the [[subacute]] [[virus]]-clearing [[Phase (matter)|phase]]. In myocarditis due to [[drug hypersensitivity]], [[patients]] may give a [[History and Physical examination|history]] of ingesting an offending [[drug]]. In [[fulminant]] myocarditis, [[patients]] present with the abrupt onset of [[flu]]-like [[symptoms]] and the abrupt onset of [[heart failure]] [[symptoms]]. In [[chronic]] and [[acute]] myocarditis, the onset of [[symptoms]] may be more insidious. Common [[symptoms]] of myocarditis include [[chest pain]], [[pedal edema]], [[palpitation]]s, [[fever]], and [[joint pain]]s. | ||
==History== | ==History== | ||
Myocarditis should be suspected in a [[patient]] with [[acute]] [[decompensation]] of [[Cardiac function curve|cardiac function]] who is at low risk of [[ischemic heart disease]]. A [[History and Physical examination|history]] of a recent (within the preceding 2-4 weeks) [[viral]] [[illness]] is often elicited in a large number of [[patients]] with myocarditis. [[Cardiac]] specific [[symptoms]] may become apparent usually in the [[subacute]] [[virus]]-clearing phase. In myocarditis due to [[drug hypersensitivity]], [[patients]] may give a [[History and Physical examination|history]] of ingesting an offending [[drug]]. [[Drugs]] associated with myocarditis include [[amphetamines]], [[benzodiazepines]], [[carbamazepine]], [[chloramphenicol]], [[clozapine]], [[cocaine]], [[cyclophosphamide]], [[dobutamine]], [[methyldopa]], [[penicillin]], [[phenytoin]], [[spironolactone]], [[streptomycin]], [[sulfonamides]], and [[tricyclic antidepressants]].<ref name="pmid17194170">{{cite journal| author=Haas SJ, Hill R, Krum H, Liew D, Tonkin A, Demos L et al.| title=Clozapine-associated myocarditis: a review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 1993-2003. | journal=Drug Saf |year= 2007 | volume= 30 | issue= 1 | pages= 47-57 | pmid=17194170 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17194170 }} </ref><ref name="pmid7578186">{{cite journal| author=Spear GS|title=Eosinophilic explant carditis with eosinophilia: ?Hypersensitivity to dobutamine infusion. | journal=J Heart Lung Transplant | year= 1995 | volume= 14 | issue= 4 | pages= 755-60 | pmid=7578186 | doi= | pmc= | url= }} </ref><ref name="pmid15090985">{{cite journal| author=Johnson MR| title=Eosinophilic myocarditis in the explanted hearts of cardiac transplant recipients: Interesting pathologic finding or pathophysiologic entity of clinical significance? | journal=Crit Care Med | year= 2004 | volume= 32 | issue= 3 | pages= 888-90 | pmid=15090985 | doi= | pmc= | http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15090985 }} </ref> | Myocarditis should be suspected in a [[patient]] with [[acute]] [[decompensation]] of [[Cardiac function curve|cardiac function]] who is at low risk of [[ischemic heart disease]]. A [[History and Physical examination|history]] of a recent (within the preceding 2-4 weeks) [[viral]] [[illness]] is often elicited in a large [[number]] of [[patients]] with myocarditis. [[Cardiac]] specific [[symptoms]] may become apparent usually in the [[subacute]] [[virus]]-clearing [[Phase (matter)|phase]]. In myocarditis due to [[drug hypersensitivity]], [[patients]] may give a [[History and Physical examination|history]] of ingesting an offending [[drug]]. [[Drugs]] associated with myocarditis include [[amphetamines]], [[benzodiazepines]], [[carbamazepine]], [[chloramphenicol]], [[clozapine]], [[cocaine]], [[cyclophosphamide]], [[dobutamine]], [[methyldopa]], [[penicillin]], [[phenytoin]], [[spironolactone]], [[streptomycin]], [[sulfonamides]], and [[tricyclic antidepressants]].<ref name="pmid17194170">{{cite journal| author=Haas SJ, Hill R, Krum H, Liew D, Tonkin A, Demos L et al.| title=Clozapine-associated myocarditis: a review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 1993-2003. | journal=Drug Saf |year= 2007 | volume= 30 | issue= 1 | pages= 47-57 | pmid=17194170 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17194170 }} </ref><ref name="pmid7578186">{{cite journal| author=Spear GS|title=Eosinophilic explant carditis with eosinophilia: ?Hypersensitivity to dobutamine infusion. | journal=J Heart Lung Transplant | year= 1995 | volume= 14 | issue= 4 | pages= 755-60 | pmid=7578186 | doi= | pmc= | url= }} </ref><ref name="pmid15090985">{{cite journal| author=Johnson MR| title=Eosinophilic myocarditis in the explanted hearts of cardiac transplant recipients: Interesting pathologic finding or pathophysiologic entity of clinical significance? | journal=Crit Care Med | year= 2004 | volume= 32 | issue= 3 | pages= 888-90 | pmid=15090985 | doi= | pmc= | http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15090985 }} </ref> | ||
==Symptoms== | ==Symptoms== | ||
===Common Symptoms=== | ===Common Symptoms=== | ||
Common symptoms of [ | Common [[symptoms]] of myocarditis include:<ref name="Feldman">Feldman AM, McNamara D. Myocarditis. ''[[New England Journal of Medicine|N Engl J Med]]'' 2000;343:1388-98. PMID 11070105.</ref><ref name="pmid11693753">{{cite journal| author=Sarda L, Colin P, Boccara F, Daou D, Lebtahi R, Faraggi M et al.| title=Myocarditis in patients with clinical presentation of myocardial infarction and normal coronary angiograms. | journal=J Am Coll Cardiol | year= 2001 | volume= 37 | issue= 3 | pages= 786-92 | pmid=11693753 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11693753 }} </ref><ref>Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R. Sudden death in young adults: a 25-year review of autopsies in military recruits. ''Ann Intern Med'' 2004;141:829-34. PMID 15583223.</ref> | ||
*[ | *[[Chest pain]] often described as stabbing, [[pleuritic]] or sharp in character | ||
*[ | *[[Swelling]] of the [[feet]] and ankels | ||
*[ | *[[Abnormal]] [[heart rhythm]] | ||
*[[Breathlessness]] | |||
*[[Fatigue]] | |||
*[[Fever]] (especially when [[infectious]], e.g. in [[rheumatic fever]]) | |||
*[[Orthopnea]] | |||
*[[Palpitation]]s | |||
===Less Common Symptoms=== | ===Less Common Symptoms=== | ||
Less common | Less common [[symptoms]] of myocarditis include: | ||
*[[Dyspnea on exertion]] | |||
*[[Syncope]] in setting of high grade [[AV block]] | |||
*[[Joint pains]] | |||
*[[Cyanosis]] may also be seen in severe cases | |||
*[[Sudden death]] (in young [[Adult|adults]], myocarditis causes up to 20% of all cases of [[sudden death]])<br /> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Medicine]] | [[Category:Medicine]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
Latest revision as of 22:51, 29 July 2020
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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
Myocarditis should be suspected in a patient with acute decompensation of cardiac function who is at low risk of ischemic heart disease. A history of a recent (within the preceding 2-4 weeks) viral illness is often elicited in a large number of patients with myocarditis. Cardiac specific symptoms may become apparent usually in the subacute virus-clearing phase. In myocarditis due to drug hypersensitivity, patients may give a history of ingesting an offending drug. In fulminant myocarditis, patients present with the abrupt onset of flu-like symptoms and the abrupt onset of heart failure symptoms. In chronic and acute myocarditis, the onset of symptoms may be more insidious. Common symptoms of myocarditis include chest pain, pedal edema, palpitations, fever, and joint pains.
History
Myocarditis should be suspected in a patient with acute decompensation of cardiac function who is at low risk of ischemic heart disease. A history of a recent (within the preceding 2-4 weeks) viral illness is often elicited in a large number of patients with myocarditis. Cardiac specific symptoms may become apparent usually in the subacute virus-clearing phase. In myocarditis due to drug hypersensitivity, patients may give a history of ingesting an offending drug. Drugs associated with myocarditis include amphetamines, benzodiazepines, carbamazepine, chloramphenicol, clozapine, cocaine, cyclophosphamide, dobutamine, methyldopa, penicillin, phenytoin, spironolactone, streptomycin, sulfonamides, and tricyclic antidepressants.[1][2][3]
Symptoms
Common Symptoms
Common symptoms of myocarditis include:[4][5][6]
- Chest pain often described as stabbing, pleuritic or sharp in character
- Swelling of the feet and ankels
- Abnormal heart rhythm
- Breathlessness
- Fatigue
- Fever (especially when infectious, e.g. in rheumatic fever)
- Orthopnea
- Palpitations
Less Common Symptoms
Less common symptoms of myocarditis include:
- Dyspnea on exertion
- Syncope in setting of high grade AV block
- Joint pains
- Cyanosis may also be seen in severe cases
- Sudden death (in young adults, myocarditis causes up to 20% of all cases of sudden death)
References
- ↑ Haas SJ, Hill R, Krum H, Liew D, Tonkin A, Demos L; et al. (2007). "Clozapine-associated myocarditis: a review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 1993-2003". Drug Saf. 30 (1): 47–57. PMID 17194170.
- ↑ Spear GS (1995). "Eosinophilic explant carditis with eosinophilia: ?Hypersensitivity to dobutamine infusion". J Heart Lung Transplant. 14 (4): 755–60. PMID 7578186.
- ↑ Johnson MR (2004). "Eosinophilic myocarditis in the explanted hearts of cardiac transplant recipients: Interesting pathologic finding or pathophysiologic entity of clinical significance?". Crit Care Med. 32 (3): 888–90. PMID 15090985. Unknown parameter
|http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=ignored (help) - ↑ Feldman AM, McNamara D. Myocarditis. N Engl J Med 2000;343:1388-98. PMID 11070105.
- ↑ Sarda L, Colin P, Boccara F, Daou D, Lebtahi R, Faraggi M; et al. (2001). "Myocarditis in patients with clinical presentation of myocardial infarction and normal coronary angiograms". J Am Coll Cardiol. 37 (3): 786–92. PMID 11693753.
- ↑ Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 2004;141:829-34. PMID 15583223.