Carditis - Revision history

Cole Ettingoff: /* Clinical Features */

2025-05-05T18:18:26Z

Clinical Features

← Older revision		Revision as of 18:18, 5 May 2025
Line 7:		Line 7:
	[[Endocarditis]]:		[[Endocarditis]]:

	Fever, new murmur, petechiae, Osler nodes, Janeway lesions		* Fever, new murmur, petechiae, Osler nodes, Janeway lesions
	May present with embolic phenomena (e.g., stroke, hematuria)		* May present with embolic phenomena (e.g., stroke, hematuria)

	[[Myocarditis]]:		[[Myocarditis]]:

	Fatigue, chest pain, palpitations		* Fatigue, chest pain, palpitations
	May mimic ACS or present with heart failure symptoms		* May mimic ACS or present with heart failure symptoms
			*
	[[Pericarditis]]:		[[Pericarditis]]:

	Sharp, pleuritic chest pain improved by sitting up		* Sharp, pleuritic chest pain improved by sitting up
	Pericardial friction rub		* Pericardial friction rub
	May show diffuse ST elevation and PR depression on ECG		* May show diffuse ST elevation and PR depression on ECG
			*
	In rheumatic carditis, signs may include:		In rheumatic carditis, signs may include:

	Tachycardia out of proportion to fever		* Tachycardia out of proportion to fever
	New or changing murmur (e.g., mitral regurgitation)		* New or changing murmur (e.g., mitral regurgitation)
	Signs of heart failure in a previously healthy child		* Signs of heart failure in a previously healthy child

	==Differential Diagnosis==		==Differential Diagnosis==

Cole Ettingoff: /* Clinical Features */

2025-05-05T18:17:51Z

Clinical Features

← Older revision		Revision as of 18:17, 5 May 2025
Line 5:		Line 5:
	Presentation depends on which layer(s) of the heart are involved:		Presentation depends on which layer(s) of the heart are involved:

	Endocarditis:		[[Endocarditis]]:

	Fever, new murmur, petechiae, Osler nodes, Janeway lesions		Fever, new murmur, petechiae, Osler nodes, Janeway lesions
	May present with embolic phenomena (e.g., stroke, hematuria)		May present with embolic phenomena (e.g., stroke, hematuria)

	Myocarditis:		[[Myocarditis]]:

	Fatigue, chest pain, palpitations		Fatigue, chest pain, palpitations
	May mimic ACS or present with heart failure symptoms		May mimic ACS or present with heart failure symptoms

	Pericarditis:		[[Pericarditis]]:

	Sharp, pleuritic chest pain improved by sitting up		Sharp, pleuritic chest pain improved by sitting up
	Pericardial friction rub		Pericardial friction rub
Line 19:		Line 22:

	In rheumatic carditis, signs may include:		In rheumatic carditis, signs may include:

	Tachycardia out of proportion to fever		Tachycardia out of proportion to fever
	New or changing murmur (e.g., mitral regurgitation)		New or changing murmur (e.g., mitral regurgitation)

Cole Ettingoff: /* Differential Diagnosis */

2025-05-05T18:17:03Z

Differential Diagnosis

← Older revision		Revision as of 18:17, 5 May 2025
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	==Differential Diagnosis==		==Differential Diagnosis==
	Infective endocarditis		* Infective endocarditis
			*
	Acute coronary syndrome		* Acute coronary syndrome
			*
	Pericarditis (viral, autoimmune, uremic)		* Pericarditis (viral, autoimmune, uremic)
			*
	Myocarditis (viral, toxic, autoimmune)		* Myocarditis (viral, toxic, autoimmune)
			*
	Sepsis-induced cardiac dysfunction		* Sepsis-induced cardiac dysfunction
			*
	Valvular disease (e.g., mitral valve prolapse, aortic stenosis)		* Valvular disease (e.g., mitral valve prolapse, aortic stenosis)
			*
	Rheumatic fever		* Rheumatic fever
			*
	Systemic lupus erythematosus (SLE)		* Systemic lupus erythematosus (SLE)
			*
	COVID-19 or post-viral inflammatory syndrome		* COVID-19 or post-viral inflammatory syndrome

	==Evaluation==		==Evaluation==

Cole Ettingoff: /* Workup */

2025-05-05T18:16:44Z

Workup

← Older revision		Revision as of 18:16, 5 May 2025
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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	Vitals + ECG (look for arrhythmias, PR prolongation, ST changes)		* Vitals + ECG (look for arrhythmias, PR prolongation, ST changes)
			*
			* Cardiac biomarkers (troponin, BNP)
			*
			* CXR (look for cardiomegaly, pulmonary edema)
			*
			* Echocardiogram (TTE or TEE if endocarditis suspected)

	~~Cardiac biomarkers (troponin, BNP)~~		* Labs:

	~~CXR (look for cardiomegaly, pulmonary edema)~~		** CBC, CMP
			*
	~~Echocardiogram (TTE or TEE if endocarditis suspected)~~		** ESR/CRP (inflammatory markers)
			*
	~~Labs:~~		** Blood cultures x2–3 (if endocarditis suspected)
			*
	CBC, CMP		** ASO or anti-DNase B titers (if rheumatic fever suspected)
			*
	ESR/CRP (inflammatory markers)		** Throat culture or rapid strep test
			*
	Blood cultures x2–3 (if endocarditis suspected)		* Consider:
			*
	ASO or anti-DNase B titers (if rheumatic fever suspected)		** ANA, rheumatoid factor (autoimmune causes)
			*
	Throat culture or rapid strep test		** COVID-19 or viral panel
			*
	Consider:		** Pericardial fluid studies if effusion and pericardiocentesis performed

	ANA, rheumatoid factor (autoimmune causes)

	COVID-19 or viral panel

	Pericardial fluid studies if effusion and pericardiocentesis performed

	===Diagnosis===		===Diagnosis===

Cole Ettingoff: Created page with "==Background== Carditis refers to inflammation of the heart, including the endocardium, myocardium, and/or pericardium. In the emergency department, carditis may present subtly or with life-threatening complications. Causes range from infectious (viral, bacterial, rheumatic) to autoimmune (SLE, vasculitis) or drug-induced. It is one of the major Jones criteria for acute rheumatic fever and can present in children or adolescents following a streptococcal infection. Prompt..."

2025-05-05T18:15:49Z

Created page with "==Background== Carditis refers to inflammation of the heart, including the endocardium, myocardium, and/or pericardium. In the emergency department, carditis may present subtly or with life-threatening complications. Causes range from infectious (viral, bacterial, rheumatic) to autoimmune (SLE, vasculitis) or drug-induced. It is one of the major Jones criteria for acute rheumatic fever and can present in children or adolescents following a streptococcal infection. Prompt..."

New page

==Background==
Carditis refers to inflammation of the heart, including the endocardium, myocardium, and/or pericardium. In the emergency department, carditis may present subtly or with life-threatening complications. Causes range from infectious (viral, bacterial, rheumatic) to autoimmune (SLE, vasculitis) or drug-induced. It is one of the major Jones criteria for acute rheumatic fever and can present in children or adolescents following a streptococcal infection. Prompt recognition is critical due to risk of valvular damage, heart failure, and arrhythmias.

==Clinical Features==
Presentation depends on which layer(s) of the heart are involved:

Endocarditis:
Fever, new murmur, petechiae, Osler nodes, Janeway lesions
May present with embolic phenomena (e.g., stroke, hematuria)

Myocarditis:
Fatigue, chest pain, palpitations
May mimic ACS or present with heart failure symptoms

Pericarditis:
Sharp, pleuritic chest pain improved by sitting up
Pericardial friction rub
May show diffuse ST elevation and PR depression on ECG

In rheumatic carditis, signs may include:
Tachycardia out of proportion to fever
New or changing murmur (e.g., mitral regurgitation)
Signs of heart failure in a previously healthy child

==Differential Diagnosis==
Infective endocarditis

Acute coronary syndrome

Pericarditis (viral, autoimmune, uremic)

Myocarditis (viral, toxic, autoimmune)

Sepsis-induced cardiac dysfunction

Valvular disease (e.g., mitral valve prolapse, aortic stenosis)

Rheumatic fever

Systemic lupus erythematosus (SLE)

COVID-19 or post-viral inflammatory syndrome

==Evaluation==
===Workup===
Vitals + ECG (look for arrhythmias, PR prolongation, ST changes)

Cardiac biomarkers (troponin, BNP)

CXR (look for cardiomegaly, pulmonary edema)

Echocardiogram (TTE or TEE if endocarditis suspected)

Labs:

CBC, CMP

ESR/CRP (inflammatory markers)

Blood cultures x2–3 (if endocarditis suspected)

ASO or anti-DNase B titers (if rheumatic fever suspected)

Throat culture or rapid strep test

Consider:

ANA, rheumatoid factor (autoimmune causes)

COVID-19 or viral panel

Pericardial fluid studies if effusion and pericardiocentesis performed

===Diagnosis===
Myocarditis/pericarditis: clinical history, ECG findings, elevated troponin, and/or imaging

Endocarditis: Modified Duke criteria (positive blood cultures + evidence on echo or vascular/immunologic findings)

Rheumatic carditis: Based on Jones Criteria (carditis + supporting evidence of recent group A strep infection)

==Management==

=== Infectious Endocarditis ===
* Start broad-spectrum antibiotics after cultures (e.g., vancomycin + ceftriaxone)
*
* Consult infectious disease and cardiology

=== Myocarditis ===

* Supportive care (oxygen, fluids cautiously, inotropes if shock)
*
* Avoid NSAIDs unless pericarditis predominant
*
* Cardiology consult and hospital admission

=== Pericarditis ===

* NSAIDs + colchicine if viral/idiopathic
*
* Avoid steroids unless autoimmune etiology
*
* Monitor for tamponade (Beck's triad, pulsus paradoxus)

=== Rheumatic Carditis ===

* Penicillin (to eradicate strep infection)
*
* Aspirin or NSAIDs for arthritis/carditis
*
* Steroids for severe carditis or heart failure symptoms
*
* Bed rest and cardiology consultation

==Disposition==
Admit if:

* Evidence of heart failure, hypotension, or hemodynamic instability
*
* Troponin elevation or suspected myocarditis
*
* Signs of tamponade or large pericardial effusion
*
* Suspected or confirmed infective endocarditis
*
* Suspected acute rheumatic fever with carditis
*
Discharge may be appropriate if:

* Stable, low-risk pericarditis with no effusion
*
* Mild, resolving symptoms and normal cardiac studies
*
* Reliable follow-up with cardiology and primary care is available
*
* All patients with suspected carditis should have follow-up within days and cardiology consultation arranged from the ED if not admitted.