Summary
Definition
History and exam
Key diagnostic factors
- viral syndrome (prior)
- autoimmune disease
- infectious disease
- drugs and toxins
Other diagnostic factors
- age <50 years
- chest pain
- dyspnea
- orthopnea
- fatigue
- palpitations
- rales
- elevated neck veins
- S3 gallop
- sinus tachycardia
- atrial and ventricular arrhythmias
- syncope
- S3 and S4 summation gallop
- pericardial friction rub
- peripheral hypoperfusion
- hypotension
- altered sensorium
- lymphadenopathy
Risk factors
- infection (non-HIV)
- HIV infection
- smallpox vaccination
- autoimmune/immune-mediated diseases
- peripartum and postpartum periods
- drugs and toxins
Diagnostic investigations
1st investigations to order
- 12-lead ECG
- CXR
- serum CK
- serum CK-MB
- serum troponin (I or T)
- serum B-type natriuretic peptide
- two-dimensional echocardiogram
Investigations to consider
- endomyocardial biopsy (EMB)
- coronary angiography
- cardiac MRI
Emerging tests
- MRI-guided EMB
Treatment algorithm
hemodynamically stable: no evidence of LV systolic dysfunction
hemodynamically stable: evidence of LV systolic dysfunction
hemodynamically unstable
end-stage heart failure or refractory life-threatening arrhythmias
Contributors
Authors
Katherine C. Wu, MD, FACC
Associate Professor of Medicine
Johns Hopkins University
School of Medicine
Baltimore
MD
Disclosures
KCW declares that she has no competing interests.
Acknowledgements
Dr Katherine Wu would like to gratefully acknowledge Dr James E. Harvey and Dr Arman T. Askari, previous contributors to this topic. JEH and ATA declare that they have no competing interests.
Peer reviewers
David A. Leaf, MD, MPH
Professor of Medicine
School of Medicine
VA Greater Los Angeles Healthcare System
UCLA
Los Angeles
CA
Disclosures
DAL declares that he has no competing interests.
John Charpie, MD, PhD
Associate Professor of Pediatrics
Medical Director
Pediatric Cardiothoracic Intensive Care Unit
University of Michigan Congenital Heart Center
Ann Arbor
MI
Disclosures
JC declares that he has no competing interests.
Lokesh Tejwani, MD, FACC
Assistant Professor of Clinical Medicine
University of Missouri Hospitals and Clinics
Harry S. Truman VA Hospital
Columbia
MO
Disclosures
LT declares that he has no competing interests.
Differentials
- Acute coronary syndrome
- Dilated cardiomyopathy
- Pericarditis
More DifferentialsGuidelines
- Diagnosis and management of myocardial involvement in systemic immune-mediated diseases: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Disease
- Current diagnostic and treatment strategies for specific dilated cardiomyopathies: A scientific statement from the American Heart Association
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