Difference between revisions of "Myocarditis physical examination"

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==Overview==
 
==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]].
+
There are no specific findings for myocarditis. [[Patients]] with myocarditis usually show [[signs]] of [[cardiac dysfunction]] and underlying [[diseases]]. 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==
 
==Physical Examination==
There are no specific findings for myocarditis. Patients with myocarditis usually show signs of heart dysfunctions and underlying diseases.<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><ref name="CaforioPankuweit2013">{{cite journal|last1=Caforio|first1=A. L. P.|last2=Pankuweit|first2=S.|last3=Arbustini|first3=E.|last4=Basso|first4=C.|last5=Gimeno-Blanes|first5=J.|last6=Felix|first6=S. B.|last7=Fu|first7=M.|last8=Helio|first8=T.|last9=Heymans|first9=S.|last10=Jahns|first10=R.|last11=Klingel|first11=K.|last12=Linhart|first12=A.|last13=Maisch|first13=B.|last14=McKenna|first14=W.|last15=Mogensen|first15=J.|last16=Pinto|first16=Y. M.|last17=Ristic|first17=A.|last18=Schultheiss|first18=H.-P.|last19=Seggewiss|first19=H.|last20=Tavazzi|first20=L.|last21=Thiene|first21=G.|last22=Yilmaz|first22=A.|last23=Charron|first23=P.|last24=Elliott|first24=P. M.|title=Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases|journal=European Heart Journal|volume=34|issue=33|year=2013|pages=2636–2648|issn=0195-668X|doi=10.1093/eurheartj/eht210}}</ref><ref name="AnziniMerlo2013">{{cite journal|last1=Anzini|first1=Marco|last2=Merlo|first2=Marco|last3=Sabbadini|first3=Gastone|last4=Barbati|first4=Giulia|last5=Finocchiaro|first5=Gherardo|last6=Pinamonti|first6=Bruno|last7=Salvi|first7=Alessandro|last8=Perkan|first8=Andrea|last9=Di Lenarda|first9=Andrea|last10=Bussani|first10=Rossana|last11=Bartunek|first11=Jozef|last12=Sinagra|first12=Gianfranco|title=Long-Term Evolution and Prognostic Stratification of Biopsy-Proven Active Myocarditis|journal=Circulation|volume=128|issue=22|year=2013|pages=2384–2394|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.113.003092}}</ref><ref name="CaforioCalabrese2007">{{cite journal|last1=Caforio|first1=A. L.P.|last2=Calabrese|first2=F.|last3=Angelini|first3=A.|last4=Tona|first4=F.|last5=Vinci|first5=A.|last6=Bottaro|first6=S.|last7=Ramondo|first7=A.|last8=Carturan|first8=E.|last9=Iliceto|first9=S.|last10=Thiene|first10=G.|last11=Daliento|first11=L.|title=A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis|journal=European Heart Journal|volume=28|issue=11|year=2007|pages=1326–1333|issn=0195-668X|doi=10.1093/eurheartj/ehm076}}</ref><ref>{{cite journal|title=Acute Myocarditis Masquerading as Acute Myocardial Infarction|journal=New England Journal of Medicine|volume=328|issue=23|year=1993|pages=1714–1715|issn=0028-4793|doi=10.1056/NEJM199306103282315}}</ref><ref name="DecWaldman1992">{{cite journal|last1=Dec|first1=G.William|last2=Waldman|first2=Howard|last3=Southern|first3=James|last4=Fallon|first4=John T.|last5=Hutter|first5=Adolph M.|last6=Palacios|first6=Igor|title=Viral myocarditis mimicking acute myocardial infarction|journal=Journal of the American College of Cardiology|volume=20|issue=1|year=1992|pages=85–89|issn=07351097|doi=10.1016/0735-1097(92)90141-9}}</ref><ref name="CaforioMarcolongo2015">{{cite journal|last1=Caforio|first1=Alida L P|last2=Marcolongo|first2=Renzo|last3=Basso|first3=Cristina|last4=Iliceto|first4=Sabino|title=Clinical presentation and diagnosis of myocarditis|journal=Heart|volume=101|issue=16|year=2015|pages=1332–1344|issn=1355-6037|doi=10.1136/heartjnl-2014-306363}}</ref>
+
There are no specific findings for myocarditis. [[Patients]] with myocarditis usually show [[signs]] of [[cardiac dysfunction]] and underlying [[diseases]].<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><ref name="CaforioPankuweit2013">{{cite journal|last1=Caforio|first1=A. L. P.|last2=Pankuweit|first2=S.|last3=Arbustini|first3=E.|last4=Basso|first4=C.|last5=Gimeno-Blanes|first5=J.|last6=Felix|first6=S. B.|last7=Fu|first7=M.|last8=Helio|first8=T.|last9=Heymans|first9=S.|last10=Jahns|first10=R.|last11=Klingel|first11=K.|last12=Linhart|first12=A.|last13=Maisch|first13=B.|last14=McKenna|first14=W.|last15=Mogensen|first15=J.|last16=Pinto|first16=Y. M.|last17=Ristic|first17=A.|last18=Schultheiss|first18=H.-P.|last19=Seggewiss|first19=H.|last20=Tavazzi|first20=L.|last21=Thiene|first21=G.|last22=Yilmaz|first22=A.|last23=Charron|first23=P.|last24=Elliott|first24=P. M.|title=Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases|journal=European Heart Journal|volume=34|issue=33|year=2013|pages=2636–2648|issn=0195-668X|doi=10.1093/eurheartj/eht210}}</ref><ref name="AnziniMerlo2013">{{cite journal|last1=Anzini|first1=Marco|last2=Merlo|first2=Marco|last3=Sabbadini|first3=Gastone|last4=Barbati|first4=Giulia|last5=Finocchiaro|first5=Gherardo|last6=Pinamonti|first6=Bruno|last7=Salvi|first7=Alessandro|last8=Perkan|first8=Andrea|last9=Di Lenarda|first9=Andrea|last10=Bussani|first10=Rossana|last11=Bartunek|first11=Jozef|last12=Sinagra|first12=Gianfranco|title=Long-Term Evolution and Prognostic Stratification of Biopsy-Proven Active Myocarditis|journal=Circulation|volume=128|issue=22|year=2013|pages=2384–2394|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.113.003092}}</ref><ref name="CaforioCalabrese2007">{{cite journal|last1=Caforio|first1=A. L.P.|last2=Calabrese|first2=F.|last3=Angelini|first3=A.|last4=Tona|first4=F.|last5=Vinci|first5=A.|last6=Bottaro|first6=S.|last7=Ramondo|first7=A.|last8=Carturan|first8=E.|last9=Iliceto|first9=S.|last10=Thiene|first10=G.|last11=Daliento|first11=L.|title=A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis|journal=European Heart Journal|volume=28|issue=11|year=2007|pages=1326–1333|issn=0195-668X|doi=10.1093/eurheartj/ehm076}}</ref><ref>{{cite journal|title=Acute Myocarditis Masquerading as Acute Myocardial Infarction|journal=New England Journal of Medicine|volume=328|issue=23|year=1993|pages=1714–1715|issn=0028-4793|doi=10.1056/NEJM199306103282315}}</ref><ref name="DecWaldman1992">{{cite journal|last1=Dec|first1=G.William|last2=Waldman|first2=Howard|last3=Southern|first3=James|last4=Fallon|first4=John T.|last5=Hutter|first5=Adolph M.|last6=Palacios|first6=Igor|title=Viral myocarditis mimicking acute myocardial infarction|journal=Journal of the American College of Cardiology|volume=20|issue=1|year=1992|pages=85–89|issn=07351097|doi=10.1016/0735-1097(92)90141-9}}</ref><ref name="CaforioMarcolongo2015">{{cite journal|last1=Caforio|first1=Alida L P|last2=Marcolongo|first2=Renzo|last3=Basso|first3=Cristina|last4=Iliceto|first4=Sabino|title=Clinical presentation and diagnosis of myocarditis|journal=Heart|volume=101|issue=16|year=2015|pages=1332–1344|issn=1355-6037|doi=10.1136/heartjnl-2014-306363}}</ref>
  
 
===General appearance===
 
===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]].
+
[[Patients]] with mild cases of myocarditis may have a non-[[toxic]] [[appearance]]. [[Patients]] with [[acute]] onset or advanced [[disease]] may [[Presenting symptom|present]] with [[signs]] of [[cardiac dysfunction]].
  
 
===Vital signs===  
 
===Vital signs===  
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*[[Tachycardia]]  
 
*[[Tachycardia]]  
 
*[[Tachypnea]]
 
*[[Tachypnea]]
*[[Fever]] (if an underlying infectious cause is present)
+
*[[Fever]] (if an underlying [[infectious]] cause is present)
 
*
 
*
  
 
===Skin===
 
===Skin===
  
*Erythema marginatum may be seen if myocarditis happens secondary to acute rheumatoid fever
+
*[[Erythema marginatum]] may be seen if myocarditis happens [[secondary]] to [[Acute (medicine)|acute]] [[rheumatic fever]]
*Subcutaneous nodules may be seen if myocarditis happens secondary to acute rheumatoid fever
+
*[[Subcutaneous]] [[nodules]] may be seen if myocarditis happens [[secondary]] to [[Acute (medicine)|acute]] [[rheumatic fever]]
*Maculopapular rash in hypersensitivity/eosinophilic myocarditis<br />
+
*[[Maculopapular rash]] in [[hypersensitivity]]/eosinophilic myocarditis<br />
  
 
===HEENT===
 
===HEENT===
  
* HEENT examination of patients with myocarditis is usually normal.
+
* HEENT examination of [[patients]] with myocarditis is usually normal.
  
 
*  
 
*  
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=== Neck ===
 
=== Neck ===
  
*[[Jugular venous distension]] may be noted if the patient has [[congestive heart failure]].
+
*[[Jugular venous distension]] may be noted if the [[patient]] has [[congestive heart failure]].
 
*[[Lymphadenopathy]] (in sarcoid myocarditis)
 
*[[Lymphadenopathy]] (in sarcoid myocarditis)
  
 
===Lungs===
 
===Lungs===
  
*The lung fields may be dull on [[percussion]] in presence of [[infection]] or [[pleural effusion]].
+
*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]].
 
*[[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]].
 
*[[Decreased breath sounds]] may be noted in presence of an accompanying [[pleural effusion]].
*[[Egophony]] may be present if consolidation of the lung is present.
+
*[[Egophony]] may be present if [[Consolidation (medicine)|consolidation]] of the [[lung]] is present.
  
 
*
 
*
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*The [[apical impulse]] may be displaced laterally if there is [[left ventricular dilation]].
 
*The [[apical impulse]] may be displaced laterally if there is [[left ventricular dilation]].
*Auscultation:  
+
*[[Auscultation]]:  
**[[S3|S<sub>3</sub>]] or occasionally a [[summation gallop]] may be noted, particularly in significant biventricular dysfunction.  
+
**[[S3|S<sub>3</sub>]] or occasionally a [[summation gallop]] may be noted, particularly in significant [[Ventricular dysfunction|biventricular dysfunction]].
 
**[[Tachycardia]] or [[arrhythmia]]
 
**[[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.
+
**[[Mitral]] or [[tricuspid]] [[murmurs]] ([[holosystolic murmur]]s) may also be noted in the presence of significant [[ventricular dilation]] leading to [[Regurgitation|regurgitant]] flow across [[Atrioventricular valves|AV valves.]]
 
**[[Pericardial friction rub]] and low intensity [[heart sounds]] may be evident if [[pericardium]] is involved causing [[pericarditis]] and [[pericardial effusion|effusion]] respectively.
 
**[[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.
+
* [[Ascites]] may be observed if [[heart failure]] and [[fluid overload]] is present.
  
 
===Genitourinary===
 
===Genitourinary===
  
* Genitourinary examination of patients with myocarditis is usually normal.
+
*[[Genitourinary]] [[examination]] of [[patients]] with myocarditis is usually normal.
  
 
===Neuromuscular===
 
===Neuromuscular===
  
* Chorea may be seen if myocarditis happens secondary to acute rheumatoid fever
+
*[[Chorea]] may be seen if myocarditis happens [[secondary]] to [[Acute (medicine)|acute]] [[rheumatic fever]]
  
 
*
 
*
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* [[Pedal edema]] may be observed if [[congestive heart failure]] and fluid overload are present.
 
* [[Pedal edema]] may be observed if [[congestive heart failure]] and fluid overload are present.
* Polyarthralgia may be seen if myocarditis happens secondary to acute rheumatoid fever.
+
*[[Polyarthralgia]] may be seen if myocarditis happens [[secondary]] to [[Acute (medicine)|acute]] [[rheumatic fever]]
  
 
==References==
 
==References==

Latest revision as of 16:00, 16 January 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

There are no specific findings for myocarditis. Patients with myocarditis usually show signs of cardiac dysfunction and underlying diseases. 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

There are no specific findings for myocarditis. Patients with myocarditis usually show signs of cardiac dysfunction and underlying diseases.[1][2][3][4][5][6][7]

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

Skin

HEENT

  • HEENT examination of patients with myocarditis is usually normal.

Neck

Lungs

Heart

Abdomen

Genitourinary

Neuromuscular

Extremities

References

  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)
  2. Caforio, A. L. P.; Pankuweit, S.; Arbustini, E.; Basso, C.; Gimeno-Blanes, J.; Felix, S. B.; Fu, M.; Helio, T.; Heymans, S.; Jahns, R.; Klingel, K.; Linhart, A.; Maisch, B.; McKenna, W.; Mogensen, J.; Pinto, Y. M.; Ristic, A.; Schultheiss, H.-P.; Seggewiss, H.; Tavazzi, L.; Thiene, G.; Yilmaz, A.; Charron, P.; Elliott, P. M. (2013). "Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases". European Heart Journal. 34 (33): 2636–2648. doi:10.1093/eurheartj/eht210. ISSN 0195-668X.
  3. Anzini, Marco; Merlo, Marco; Sabbadini, Gastone; Barbati, Giulia; Finocchiaro, Gherardo; Pinamonti, Bruno; Salvi, Alessandro; Perkan, Andrea; Di Lenarda, Andrea; Bussani, Rossana; Bartunek, Jozef; Sinagra, Gianfranco (2013). "Long-Term Evolution and Prognostic Stratification of Biopsy-Proven Active Myocarditis". Circulation. 128 (22): 2384–2394. doi:10.1161/CIRCULATIONAHA.113.003092. ISSN 0009-7322.
  4. Caforio, A. L.P.; Calabrese, F.; Angelini, A.; Tona, F.; Vinci, A.; Bottaro, S.; Ramondo, A.; Carturan, E.; Iliceto, S.; Thiene, G.; Daliento, L. (2007). "A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis". European Heart Journal. 28 (11): 1326–1333. doi:10.1093/eurheartj/ehm076. ISSN 0195-668X.
  5. "Acute Myocarditis Masquerading as Acute Myocardial Infarction". New England Journal of Medicine. 328 (23): 1714–1715. 1993. doi:10.1056/NEJM199306103282315. ISSN 0028-4793.
  6. Dec, G.William; Waldman, Howard; Southern, James; Fallon, John T.; Hutter, Adolph M.; Palacios, Igor (1992). "Viral myocarditis mimicking acute myocardial infarction". Journal of the American College of Cardiology. 20 (1): 85–89. doi:10.1016/0735-1097(92)90141-9. ISSN 0735-1097.
  7. Caforio, Alida L P; Marcolongo, Renzo; Basso, Cristina; Iliceto, Sabino (2015). "Clinical presentation and diagnosis of myocarditis". Heart. 101 (16): 1332–1344. doi:10.1136/heartjnl-2014-306363. ISSN 1355-6037.



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