Myocarditis physical examination: Difference between revisions
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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}} | ||
Revision as of 22:22, 14 January 2020
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Myocarditis Microchapters |
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Diagnosis |
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Treatment |
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Myocarditis physical examination On the Web |
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American Roentgen Ray Society Images of Myocarditis physical examination |
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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] 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
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