Myocarditis physical examination: Difference between revisions
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==Overview== | ==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== | ==Physical Examination== | ||
===General appearance=== | ===General appearance=== | ||
Patients with mild cases of [[myocarditis]] may have a nontoxic appearance or simply | Patients with mild cases of [[myocarditis]] may have a nontoxic appearance or may simply 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]] ( | *[[Hypotension]] (if severe [[left ventricular systolic dysfunction]] is present) | ||
*[[Tachycardia]] | *[[Tachycardia]] | ||
*[[Tachypnea]] | *[[Tachypnea]] | ||
*[[Fever]] ( | *[[Fever]] (if an underlying infectious cause is present) | ||
===Cardiac examination=== | ===Cardiac examination=== | ||
Revision as of 15:25, 5 September 2011
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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.
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 nontoxic appearance or may simply appear to have a viral syndrome. 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)
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.
Extremities
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.