MYOCARDITIS & EMERGENCIES
What key clinical feature distinguishes myocarditis from acute MI?
Fever or recent viral illness preceding chest pain symptoms.
This textbook term describes tightening or cramping triggered by exercise and rapidly relieved by rest.
What is claudication
This temporary, curtain-like loss of vision in one eye, especially with a Hollenhorst plaque on fundoscopy, signals significant carotid bifurcation stenosis.
What is amaurosis fugax?
Chest pain in myocarditis is usually this type, which is worse with deep breathing and lying flat.
Pleuritic chest pain
A reduced ankle-brachial index combined with this metabolic disease is associated with rest pain and ulceration from inadequate perfusion.
What is diabetes
This is new-onset angina that occurs within 1 month. It requires emergency department referral.
What is unstable angina?
This is the required disposition for any patient in whom myocarditis is suspected, because it can progress to arrhythmias and cardiogenic shock.
What is emergent cardiovascular referral or the ER?
What is the normal ABI range and at what level does PAD become significant?
Normal ABI is 0.9-1.1; ABI less than 0.9 indicates PAD.
Producing pink-colored foam or mucus when coughing is a symptom of this condition.
What is heart failure?
This is the gold standard diagnostic test for myocarditis, although it is rarely used in practice.
Endomyocardial biopsy (EMB)
This is the initial diagnostic test for PAD, done at rest alongside a thorough history and physical exam. It compares ankle systolic pressure to brachial systolic pressure.
What is the ankle-brachial index (ABI)?
In any patient with chest pain, always rule out these five: ACS, PE, aortic dissection, pneumothorax, and this one.
What is esophageal rupture?
Name the two most dangerous immediate complications of myocarditis.
Sudden cardiac death (from life-threatening arrhythmias) and cardiogenic shock.
A sudden onset of a pale, cold, pulseless limb is an acute emergency caused by this condition, in which delayed treatment can impair limb viability or threaten life.
What is acute arterial occlusion?
Pain in the toes that wakes the patient from sleep and is relieved by letting the leg hang down signals this advanced stage of PAD.
What is rest pain?