**3.5 Other symptoms**

Apart from the nonspecific symptoms recognized like malaise, myalgias and arthralgias, other extracardiac symptoms may identify infectious, toxic agents or autoimmune diseases affecting the heart and resulting in a myocarditis. A viral prodrome of fever, myalgias, and muscle tenderness may precede viral myocarditis, while a delayed hypersensitivity reaction may be first apparent from a cutaneous rash. Rash, fever, peripheral eosinophilia, or a temporal relation with recently initiated medications or the use of multiple medications suggest a possibility of hypersensitivity myocarditis.

The clinical diagnosis of myocarditis is challenging due to its varying presentation, nonspecific symptoms and physical findings. Accordingly, a high level of clinical suspicion is warranted and a presumptive diagnosis usually made based on patient demographics and the clinical course.
