A physical examination is performed by a physician immediately after when a patient arrives at the doctor´s office. It could have different results at myocarditis. It is not unusual that the results are normal or atypical. Sometimes myocarditis can present as a common viral disease. Doctors can observe a number of various symptoms at their patients, for example:

• Increased temperature (subfebrile) or fever (febrile temperature)
• Increased jugular pressure (high pressure in right atrium and ventricle of heart accompanied with increased filling of jugular “neck” veins)
• Enlargement of liver during manual examination (hepatomegaly)
• Increased amount of fluid in abdominal cavity (ascites)
• Peripheral swelling (e. g. symmetric swelling of ankles/shank)
• Accelerated breathing (tachypnoea)
• Accelerated heart rate (tachycardia), which is not proportional to increased body temperature
• Increased blood volume (hypervolemia)
• Bluish colour of skin and mucosa (cyanosis)

During the examination with a stethoscope, some pathological (“unhealthy”) findings can be observed:

• Weakening of the 1^st heartbeat, alternatively presence of the 3^rd (and 4^th) heartbeat, instead of two “normal” (bordered) heartbeats.
• Murmur under the mitral valve (valve between left atrium and ventricle) and/or tricuspid valve (valve between right atrium and ventricle)
• Pericardial and/or pleural murmur (the first one is present during the beginning of pericarditis, still without pericardial effusion. Pleural murmur is in translation a murmur caused by a mutual friction of pleural and visceral sheets (in expert terminology it means sheets – “membranes” of pleura. Mostly, the pleural murmur is reliant on breathing movements.)
• An important finding is an auscultatory finding of crackles on the bases (lower part) of lungs in some cases. The crackles indicate blood engorgement during a so called left-side circulation failure. When the function of the left heart ventricle and atrium get worse, the result is that a lower blood volume is pumped from the lungs to the body. Then blood accumulates in the alveolus (air sacks), where the “exchange” of carbon dioxide and oxygen is performed.

In some cases or in situation, when we are talking about a rare type of myocarditis or myocarditis, which is caused by another disease, some other symptoms may be observed:

• Thromboembolic symptoms (production of blood clots)
• Increased lymph nodes
• Itchiness and rash (this can associate with hypersensitive myocarditis)
• Symptoms of rheumatic fever

Author of the opening picture: Johannes Jansson