Myocarditis history and symptoms


 * Associate Editor-In-Chief:: Varun Kumar, M.B.B.S.

Overview
The symptoms and the intensity of symptoms associated with myocarditis are variable. Myocarditis may be associated with no symptoms. If symptoms are present,they may be similar to the flu. Patients may present with chest pain as a result of the inflammatory process involving the myocardium or with symptoms of congestive heart failure. Patients may complain of palpitations, a racing heart or syncope. In fulminant myocarditis, patients present with the abrupt onset of flu-like symptoms and the abrupt onset of heart failure symptoms. In chronic and acute myocarditis, the onset of symptoms may be more insidious.

History
Myocarditis should be suspected in a patient with acute decompensation of cardiac function who is at low risk of ischemic heart disease.

A history of a recent (within the preceding 2-4 weeks) viral illness is often elicited in a large number of patients with myocarditis. Cardiac specific symptoms may become apparent usually in the subacute virus-clearing phase.

In myocarditis due to drug hypersensitivity, patients may give a history of ingesting the offending drug. Drugs associated with myocarditis include Amphetamines, Benzodiazepines, Carbamazepine, Chloramphenicol, Clozapine, Cocaine, Cyclophosphamide, Dobutamine, Methyldopa, Penicillin, Phenytoin, Spironolactone, Streptomycin, Sulfonamides, Tricyclic antidepressants.

Symptoms
Symptoms of myocarditis include:
 * Chest pain is often described as stabbing, pleuritic or sharp in character. In a series, 78% of patients were diagnosed with myocarditis when they presented with chest pain.
 * Pedal edema in volume overload states.
 * Breathlessness
 * Dyspnea on exertion
 * Orthopnea in pulmonary congestion.
 * Palpitations
 * Syncope in setting of high grade AV block
 * Fever (especially when infectious, e.g. in rheumatic fever)
 * Joint pains, and fatigue as seen in viral illness.
 * Cynosis may also be seen in severe cases.
 * Sudden death (in young adults, myocarditis causes up to 20% of all cases of sudden death). This is often due to ventricular tachycardia or fibrillation, but may also be due to congestive heart failure.