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Varun Kumar (talk | contribs) New page: {{Myocarditis}} {{CMG}}; '''Associate Editor(s)-In-Chief:''' Varun Kumar, M.B.B.S. ==Physical Examination== ===General appearance=== Patients with mild cases of myocarditis may ha... |
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==Physical Examination== | ==Physical Examination== | ||
===General appearance=== | ===General appearance=== | ||
Patients with mild cases of [[myocarditis]] may have a nontoxic appearance or simply may appear to have a viral syndrome. Patients with acute onset may present with signs of cardiac dysfunction. | Patients with mild cases of [[myocarditis]] may have a nontoxic appearance or simply may appear to have a viral syndrome. Patients with acute onset or advanced disease may present with signs of cardiac dysfunction. | ||
===Vital signs=== | ===Vital signs=== | ||
*[[Hypotension]] (in left ventricular systolic dysfunction) | *[[Hypotension]] (in left ventricular systolic dysfunction) | ||
*[[Tachycardia]] | *[[Tachycardia]] | ||
*[[Tachypnea]] | |||
*[[Fever]] (infective cause) | *[[Fever]] (infective cause) | ||
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*[[Jugular venous distension]] may be noted if the patient has cardiac dysfunction or [[cardiac failure|failure]] | *[[Jugular venous distension]] may be noted if the patient has cardiac dysfunction or [[cardiac failure|failure]] | ||
*Apical impulse may be displaced laterally which would be suggestive of enlargement of ventricles. | *Apical impulse may be displaced laterally which would be suggestive of enlargement of ventricles. | ||
* | *Auscultation: | ||
**[[S3|S<sub>3</sub>]] or occasionally summation | **[[S3|S<sub>3</sub>]] or occasionally summation gallop may be noted, particularly in significant biventricular dysfunction. | ||
**[[Tachycardia]] | **[[Tachycardia]] or [[arrhythmia]] | ||
**Mitral or tricuspid murmurs ([[holosystolic | **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. | ||
**[[Pericardial friction rub]] and low intensity [[heart sounds]] may be evident if [[pericardium]] is involved causing [[pericarditis]] and [[pericardial effusion|effusion]] respectively. | |||
===Respiratory examination=== | |||
*Lung fields may be dull on purcussion in presence of [[infection]], [[pulmonary edema]] 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 [[pleural effusion]]. | |||
===Abdominal examination=== | |||
[[Ascites]] may be noted in fluid overload states. | |||
===Limbs=== | |||
Pedal edema may be noted in fluid overload states such as [[cardiac failure]]. | |||
===Cause specific findings=== | |||
*'''Hypersensitive/eosinophilic myocarditis:''' Pruritic maculopapular rash | |||
*'''Acute rheumatic fever:''' Components of [[Jones criteria]] such as [[erythema marginatum]], [[polyarthralgia]], [[chorea]], [[subcutaneous nodules]]. | |||
==References== | ==References== | ||
Revision as of 18:59, 19 August 2011
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Myocarditis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Myocarditis physical examination On the Web |
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American Roentgen Ray Society Images of Myocarditis physical examination |
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Risk calculators and risk factors for Myocarditis physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.
Physical Examination
General appearance
Patients with mild cases of myocarditis may have a nontoxic appearance or simply may appear to have a viral syndrome. Patients with acute onset or advanced disease may present with signs of cardiac dysfunction.
Vital signs
- Hypotension (in left ventricular systolic dysfunction)
- Tachycardia
- Tachypnea
- Fever (infective cause)
Cardiac examination
- Jugular venous distension may be noted if the patient has cardiac dysfunction or failure
- Apical impulse may be displaced laterally which would be suggestive of enlargement of ventricles.
- Auscultation:
- S3 or occasionally 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.
Respiratory examination
- Lung fields may be dull on purcussion in presence of infection, pulmonary edema 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 pleural effusion.
Abdominal examination
Ascites may be noted in fluid overload states.
Limbs
Pedal edema may be noted in fluid overload states such as cardiac failure.
Cause specific findings
- Hypersensitive/eosinophilic myocarditis: Pruritic maculopapular rash
- Acute rheumatic fever: Components of Jones criteria such as erythema marginatum, polyarthralgia, chorea, subcutaneous nodules.