Fever is common, as is sinus tachycardia, which is usually "out of proportion" with respect to the extent of temperature elevation. Signs and symptoms depend on the extent of myocardial involvement and resultant depression of myocardial systolic function. In severe cases, progressive heart failure, with its associated symptoms, may be seen. With less extensive myocardial involvement, pericarditis and the clinical manifestations of systemic illness (fever, myalgias, headache, and rigors) may overshadow clinical signs of myocardial dysfunction, and myocarditis may not be suspected. Retrosternal or precordial chest pain is a frequent presenting complaint and is most commonly secondary to associated pericardial inflammation (myopericarditis). This chest pain may mimic angina in its character. A pericardial friction rub is commonly heard in patients with myopericarditis.15
The chest roentgenogram is usually normal, and reported abnormalities (cardiomegaly and pulmonary venous hypertension and/or pulmonary edema) vary with disease severity and are nondiagnostic. Reported ECG changes include nonspecific ST-T-wave changes, ST-segment elevation (due to associated pericarditis), atrioventricular block, and prolonged QRS duration. Levels of cardiac enzymes (creatine kinase and CK-MB) and troponin may be elevated. 16 Echocardiographic studies may reveal depressed systolic function in severe cases.
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