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
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.