Myocarditis physical examination: Difference between revisions
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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 | 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 | [[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=== | ||
| Line 16: | Line 16: | ||
*[[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 | *[[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 | *[[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. | ||
* | * | ||
| Line 33: | Line 33: | ||
=== 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. | ||
* | * | ||
| Line 48: | Line 48: | ||
*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 | *[[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 | *[[Polyarthralgia]] may be seen if myocarditis happens [[secondary]] to [[Acute (medicine)|acute]] [[rheumatic fever]] | ||
==References== | ==References== | ||
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
- Hypotension (if severe left ventricular systolic dysfunction is present)
- Tachycardia
- Tachypnea
- Fever (if an underlying infectious cause is present)
Skin
- Erythema marginatum may be seen if myocarditis happens secondary to acute rheumatic fever
- Subcutaneous nodules may be seen if myocarditis happens secondary to acute rheumatic fever
- Maculopapular rash in hypersensitivity/eosinophilic myocarditis
HEENT
- HEENT examination of patients with myocarditis is usually normal.
Neck
- Jugular venous distension may be noted if the patient has congestive heart failure.
- Lymphadenopathy (in sarcoid myocarditis)
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
- 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 myocarditis is usually normal.
Neuromuscular
- Chorea may be seen if myocarditis happens secondary to acute rheumatic fever
Extremities
- Pedal edema may be observed if congestive heart failure and fluid overload are present.
- Polyarthralgia may be seen if myocarditis happens secondary to acute rheumatic fever
References
- ↑ 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) - ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ "Acute Myocarditis Masquerading as Acute Myocardial Infarction". New England Journal of Medicine. 328 (23): 1714–1715. 1993. doi:10.1056/NEJM199306103282315. ISSN 0028-4793.
- ↑ 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.
- ↑ 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.