Ver el código de «Carditis»

==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)
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* Cardiac biomarkers (troponin, BNP)
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* CXR (look for cardiomegaly, pulmonary edema)
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* Echocardiogram (TTE or TEE if endocarditis suspected)

* Labs:

** CBC, CMP
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** ESR/CRP (inflammatory markers)
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** Blood cultures x2–3 (if endocarditis suspected)
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** ASO or anti-DNase B titers (if rheumatic fever suspected)
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** Throat culture or rapid strep test
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* Consider:
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** ANA, rheumatoid factor (autoimmune causes)
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** COVID-19 or viral panel
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** 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)
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* Consult infectious disease and cardiology

=== Myocarditis ===

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

=== Pericarditis ===

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

=== Rheumatic Carditis ===

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

==Disposition==
Admit if:

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

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