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Review
. 2018 Mar 23;115(12):193-199.
doi: 10.3238/arztebl.2018.0193.

Cardiogenic Causes of Fever

Jan Smid  1 , Maximilian Scherner, Oliver Wolfram, Thomas Groscheck, Jens Wippermann, Rüdiger C Braun-Dullaeus
Affiliations
Review

Cardiogenic Causes of Fever

Jan Smid et al. Dtsch Arztebl Int. .

Abstract

Background: Persistent fever of unknown cause is only rarely of cardiac origin, but heart disease must be considered in the differential diagnosis. Aside from endocarditis, pericarditis and various other conditions may be responsible.

Methods: This review is based on pertinent articles retrieved by a selective search in PubMed and Google Scholar employing the term "fever" in combination with "myocardial infarction," "pericarditis," "endocarditis," and "postcardiac injury," with additional consideration of current cardiological guidelines.

Results: Endocarditis is associated with fever in 90% of cases, but 25-50% of patients also develop high body temperatures after acute myocardial infarction. In pericarditis, a temperature above 38°C indicates a poorer prognosis; if accompanied by other warning signs, it is an indication for hospitalization and pericardiocentesis. Fever can arise after cardiac surgical procedures as a manifestation of post - cardiotomy syndrome, a special type of perimyocarditis. There may be a latency period of up to 3 months.

Conclusion: Fever can have both infectious and non-infectious cardiac causes. Its interpretation depends on the clinical context. The evidence base for treatment is sparse, and controlled trials are needed.

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Figures

Figure 1
Figure 1
Distribution of cardiological causes in patients with pyrexia of unknown origin according to the study by Vanderschueren et al. (e9), the largest and most detailed prospective investigation into the causes of persistent fever. With regard to our study, high numbers of cases of “cardiac” fever are found mainly in connection with endocarditis; pericarditis can occur in association with several of the disease groups (tuberculosis, neoplasia, noninfectious inflammatory diseases [NIID]). Due to the required disease duration of at least 3 weeks, it is unlikely that these statistics include any cases of post-myocardial infarction fever.
Figure 2
Figure 2
A mitral valve imaged by transesophageal echocardiography: intercommissural slice with typical vegetations (arrows) as major criterion for infectious endocarditis
See this image and copyright information in PMC

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