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.

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