Skip to Main Content


The myocardium can be affected by inflammatory (infectious or immune-mediated), metabolic, infiltrative, ischemic, or primary disease processes. These disorders may be inherited and may have significant overlap (eTable 489.1). Myocardial diseases may present acutely, with signs of congestive heart failure that include tachypnea, often with rales; tachycardia; an enlarged but quiet heart; soft heart sounds that may have a tic-tac rhythm; cardiac gallops; and either no murmurs or systolic murmurs of mitral or tricuspid regurgitation. Alternatively, they may present chronically with failure to thrive, decreased exercise tolerance, and more subtle findings of heart failure. Occasionally, the predominant process may be an arrhythmia, either atrial or ventricular tachycardia/fibrillation, or heart block. These present clinically with palpitations, syncope, or sudden death. The electrocardiogram and chest x-ray are useful in confirming the presence of heart disease, but are rarely diagnostic.

Table Graphic Jump Location
eTable 489.1. Causes of Myocardial Disease

In acute presentations, the chest x-ray usually shows diffuse cardiac enlargement, passive pulmonary congestion, and interstitial edema; the electrocardiogram shows ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.