Heart Inflammation - Diagnosis - Diagnosis

Because the signs and symptoms of heart inflammation vary among the three types and from one person to the next, it is sometimes difficult to diagnose endocarditis, pericarditis, or myocarditis. To help, your doctor may ask questions such as these:

• Have you had endocarditis, myocarditis, or pericarditis in the past?
• Have you had a recent illness or injury to the chest?
• Have you had any symptoms, such as fever, chest pain, or shortness of breath?
• Have you any other medical conditions or any other risk factors for heart inflammation, including exposure to certain medicines or toxins or a travel history that may be significant?

During the physical exam, your doctor may take these steps:

• Check your legs for swelling, a sign of heart failure
• Check your skin for any changes, as may be seen in cases of endocarditis
• Check your temperature to determine if you have a fever
• Feel your stomach, particularly for a spleen that is larger than normal, or to determine if you have abdominal pain, which may occur with endocarditis
• Listen to your heart for a new murmur that may be heard with endocarditis, a pericardial rub that may be heard with pericarditis, or an abnormal heart rhythm
• Listen to your lungs

Your doctor may recommend other tests and procedures to diagnose the different types of heart inflammation, including:

• Echocardiography (echo) to look for heart valve problems, problems in the structure or function of the heart, or a thickening of the pericardium
• Electrocardiogram (ECG or EKG) to look for changes in your heart’s electrical activity, which do not necessarily indicate myocarditis, endocarditis, or pericarditis. It may help distinguish a heart attack from pericarditis.
• Cardiac magnetic resonance imaging (MRI) to detect inflammation and swelling of the myocardium and pericardium. Your doctor may also use MRI to look for complications of endocarditis in other parts of the body, such as the brain, which may indicate stroke.
• Cardiac computed tomography (CT) to help diagnose pericarditis, as well as the complications of endocarditis and pericarditis
• Endomyocardial biopsy (EMB) to test very small pieces of the heart to look for myocarditis
• Heart valve tissue testing to identify the microbes from the heart valve or its vegetation that may be causing your endocarditis
• Pericardiocentesis to remove excess fluid in the pericardium, called a pericardial effusion. Your doctor will insert a needle or tube, called a catheter, into the chest wall to remove this excess fluid. Your doctor will look at the fluid for bacteria, signs of cancer, or other causes of pericarditis.
• Positron emission tomography (PET) scan or nuclear medicine scan to diagnose endocarditis, myocarditis, or pericarditis. In both types of imaging studies, a small amount of a radioactive substance is given to see where the body takes it up. This may indicate infection, cancer, or other conditions in the places where it shows up on imaging.

Blood tests may help your doctor find the cause of your heart inflammation and may include:

• Blood cultures to identify and treat the exact bacterium, virus, or fungus that is causing the infection in endocarditis or pericarditis
• Cardiac troponins or creatine kinase-MB, which are blood markers that increase when there is damage to your heart. Since there are no specific blood tests for myocarditis, these markers are useful to show injury to the heart muscle. However, they are also increased with heart attack or heart failure and do not necessarily mean you have myocarditis. They are often normal in cases of subacute or chronic myocarditis.
• C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), which may indicate inflammation in the body if higher than normal
• Complete blood count to look for higher levels of white blood cells, which might indicate infection
• Serum cardiac autoantibodies (AAbs), which are antibodies that your body may start to make if you have myocarditis. These antibodies recognize your own heart muscle.
• Testing for specific organisms, such as Borrelia burgdorferi, which causes Lyme disease; Mycobacterium tuberculosis, which causes tuberculosis; HIV; or hepatitis C

Your doctor may order additional tests to find out whether another condition may be causing your symptoms.

• Blood markers of autoimmune disease, such as anti-nuclear antibodies (ANAs) and anti-neutrophil cytoplasm antibodies (ANCAs), may be tested if your doctor suspects an autoimmune cause.
• Coronary angiogram may be performed if you have symptoms similar to those of a heart attack, such as chest pain or pressure. This test will tell the doctor whether your symptoms are from ischemic heart disease.

• Return to Risk Factors to review genetic factors, lifestyle choices, or medical conditions that increase your risk of developing heart inflammation.
• Return to Signs, Symptoms, and Complications to review common signs and symptoms of endocarditis, myocarditis, or pericarditis.
• Return to Screening and Prevention to review how to screen for heart inflammation.