Myocarditis physical examination

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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.

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.