cardiovascular disorders
Myocarditis
Symptoms and Signs of Myocarditis
The clinical presentation of myocarditis is variable. Patients may be minimally symptomatic or have fulminant Heart Failure (HF) and fatal Heart failure symptoms may include fatigue, dyspnea, and edema. Patients may show signs of fluid overload with crackles, elevated jugular venous pulses, and edema. Cardiac examination may be significant for a third (S3) or fourth (S4) heart sound. Systolic murmurs of Mitral Regurgitation and Cardiac Arrest due to a fatal arrhythmia is sometimes the presenting feature. Patients may experience preceding palpitations or syncope. When patients have concomitant pericardial inflammation, they may present with chest pain typical of pericarditis. Dull or sharp precordial or substernal pain may radiate to the neck, trapezius ridge (especially the left), or shoulders. Pain ranges from mild to severe. Unlike ischemic chest pain, pain due to pericarditis is usually aggravated by thoracic motion, cough, breathing, or swallowing food; it may be relieved by sitting up and leaning forward. A pericardial friction rub may be auscultated in patients with a pericardial effusion. Certain clinical findings may be indicative of a specific cause of myocarditis. Infectious myocarditis may be preceded by symptoms of fever, myalgias, and other symptoms depending on the exact pathogen. Drug-related or hypersensitivity myocarditis may be accompanied by a rash. Enlarged lymph nodes may be indicative of sarcoidosis as the underlying etiology. Fulminant heart failure and arrhythmias may be indicative of giant cell myocarditis. Myocarditis can be acute, subacute, or chronic. There are no set time-frames for each phase. The acute phase typically lasts a few days while the subacute phase lasts weeks to months. If myocarditis does not resolve after a few months, it is called chronic myocarditis. In some cases, myocarditis can lead to Dilated Cardiomyopathy . 