Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ KEY FEATURES ++ ESSENTIALS OF DIAGNOSIS ++ Muscle weakness, characteristic skin lesions Arrhythmias or conduction disturbances Myocarditis, pericarditis, coronary arteritis, and valve disease ++ GENERAL CONSIDERATIONS ++ Polymyositis/dermatomyositis is a chronic inflammatory myopathy that presents as symmetric proximal muscle weakness and a rash, usually over the extensor surfaces of the hands and the face, neck, and chest The incidence is about 1–5 new cases per million per year in the United States It strikes adults in their fourth to sixth decades African-American women are more often affected Occasionally the condition is associated with other connective tissue diseases Cardiovascular disease is a common cause of mortality ++ CLINICAL PRESENTATION ++ SYMPTOMS AND SIGNS ++ Palpitation due to ectopic beats Congestive heart failure findings, such as dyspnea on exertion and edema Chest pain due to pericarditis ++ PHYSICAL EXAM FINDINGS ++ Pericardial rub, elevated jugular venous pressure Pulmonary rales, S3, enlarged apical impulse Right ventricular lift, loud P2 Murmur of mitral regurgitation Skin manifestations ++ DIFFERENTIAL DIAGNOSIS ++ Other connective tissue diseases Other causes of cardiac disease ++ DIAGNOSTIC EVALUATION ++ LABORATORY TESTS ++ Elevated brain natriuretic peptide or troponins ++ ELECTROCARDIOGRAPHY ++ ST-T–wave abnormalities in about 50% Fascicular and bundle branch blocks Atrioventricular blocks Premature atrial and ventricular beats ++ IMAGING STUDIES ++ Chest x-ray: – Cardiomegaly – Pulmonary congestion Echocardiography: – Pericardial effusion – Left ventricular wall motion abnormalities and reduced ejection fraction – Enlarged right heart and Doppler evidence of increased pulmonary pressure – Mitral valve prolapse in about 50% – Hyperkinetic heart syndrome in some Myocardial perfusion imaging with technetium-99m pyrophosphate shows myocardial uptake Cardiac MRI with late gadolinium enhancement of the epicardium and mid-wall of the lateral and septal walls ++ DIAGNOSTIC PROCEDURES ++ Cardiac catheterization or CT coronary angiography may be required if coronary vasculitis is suspected ++ TREATMENT ++ CARDIOLOGY REFERRAL ++ Suspected heart disease ++ HOSPITALIZATION CRITERIA ++ Pericarditis Heart failure Significant arrhythmias or heart block ++ MEDICATIONS ++ Specific anti-inflammatory pharmacotherapy Specific cardiac therapy as indicated Pulmonary vasodilators in selected cases ++ THERAPEUTIC PROCEDURES ++ Percutaneous coronary intervention may be required Pericardiocentesis may be required. ++ SURGERY ++ Valve, coronary, or pericardial surgery is rare ++ MONITORING ++ ECG monitoring in hospital as appropriate ++ DIET AND ACTIVITY ++ Low-sodium diet if heart failure Restricted activity if heart failure or myocarditis ++ ONGOING MANAGEMENT ++ HOSPITAL DISCHARGE CRITERIA ++ Resolution ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. What is MyAccess? Create a FREE MyAccess profile to: Use this site remotely Bookmark your favorite content Track your self-assessment progress and more! GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessCardiology 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessCardiology Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options