Myocarditis physical examination: Difference between revisions
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===Skin=== | ===Skin=== | ||
* | *Erythema marginatum may be seen if myocarditis happens secondary to acute rheumatoid fever | ||
*Subcutaneous nodules may be seen if myocarditis happens secondary to acute rheumatoid fever | |||
*Maculopapular rash in hypersensitivity/eosinophilic myocarditis<br /> | |||
===HEENT=== | ===HEENT=== | ||
* HEENT examination of patients with | * HEENT examination of patients with myocarditis is usually normal. | ||
* | * | ||
=== Neck === | |||
===Neck=== | |||
*[[Jugular venous distension]] may be noted if the patient has [[congestive heart failure]]. | |||
*[[Lymphadenopathy]] (in sarcoid myocarditis) | |||
*[[Jugular venous distension]] | |||
*[[Lymphadenopathy]] ( | |||
===Lungs=== | ===Lungs=== | ||
| Line 60: | Line 44: | ||
===Heart=== | ===Heart=== | ||
*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: | ||
| Line 74: | Line 58: | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with | * Genitourinary examination of patients with myocarditis is usually normal. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* | * Chorea may be seen if myocarditis happens secondary to acute rheumatoid fever | ||
* | * | ||
===Extremities=== | ===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 rheumatoid fever. | |||
==References== | ==References== | ||
Revision as of 15:33, 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
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
- Erythema marginatum may be seen if myocarditis happens secondary to acute rheumatoid fever
- Subcutaneous nodules may be seen if myocarditis happens secondary to acute rheumatoid 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 rheumatoid 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 rheumatoid 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
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