Myocarditis

detail description of the myocarditis

1. MYOCARDITIS MISS. SAHELI CHAKRABORTY 1 ST YEAR M.Sc NURSING MSRINER

2. LAYERS OF THE HEART

3. MYOCARDITIS Myocarditis is a focal or diffuse inflammation of the myocardium. Myocarditis can cause heart dilation, thrombi on the heart wall (mural thrombi), infiltration of circulating blood cells around the coronary vessels and between the muscle fibers, and degeneration of the muscle fibers themselves. Myocarditis causes the heart muscle to become thick and swollen.

4. ETIOLOGY:- 50% etiologies are Idiopathic. There are 2 main types of etiologies are related to myocarditis. Infectious causes Non infectious causes

5. A. INFECTIOUS CAUSES:- Virus - Coxsackie A and B , HIV, Influenza A. Bacterial infection - Diptheria, Lyme’s disease (also known as Lyme borreliosis, is an infectious disease caused by bacteria of the  Borrelia  type which is spread by deer ticks). Rickettsial infection . Fungal infection . Protozoal Infection (eg. Chagas disease caused by Trypanosoma leads to necrosis of heart muscle) Metazoal infection. Parasitic infection. Spirochetal infection .

6. B. NON INFECTIOUS CAUSE:- Granulomatous inflammatory disease (eg. sarcoidosis , giant cell myocarditis). Rheumatic fever. Transplant rejection. Patients receiving immunosuppressive therapy . It can develop in patients with infective endocarditis , Crohn disease, and systemic lupus erythematous . Results from an inflammatory reaction to toxin such as alcohol, radiation (especially to the left chest or upper back) , chemicals, and drugs ( Anthracyclines for cancer therapy)

7. RISK FACTOR--MYOCARDITIS Treatment of URI. Post Pericarditis . Metabolic-lupus. Heat stroke . Hypothermia .

8. PATHOPHYSIOLOGY

9. CLINICAL FEATURES:- The symptoms of acute myocarditis depend on the type of infection, the degree of myocardial damage, and the capacity of the myocardium to recover. Patients may be asymptomatic , which an infection that resolves on its own. Mild myocarditis shows general symptoms . General symptoms :- fatigue, fever, shortness of breath, palpitations, occasional discomfort in the chest and upper abdomen. The most common symptoms are flulike symptoms . Symptoms of moderate myocarditis include- Positional chest pain( it can be better or worst depending on body position). Arrhythmia (irregular heart beat. Because the inflammation affects the pacemaker cells of the heart). In severe cases sudden cardiac dearth , quickly develop severe congestive heart failure, fluid retention in feet and ankles.

10. DIAGNOSTIC EVALUTION History collection. Physical examination :- A physical examination may show no abnormalities , or may reveal the following: - Abnormal heartbeat Fever Tachycardia Edema in the legs. An Electrocardiogram : T wave inversions ; saddle-shaped ST segment elevations may be present. Chest X-Ray . Lab test- elevated WBC count, increase ESR, elevated C-reactive protein (CRP) , elevated cardiac biomarkers.

11. Echocardiogram- dysrhythmias . Magnetic resonance imaging ( MRI) scan Heart biopsy

12. MANAGEMENT:- The patient receives specific treatment for the underlying cause if it is known ( eg , penicillin for hemolytic streptococci ) and is placed on bed rest to decrease the cardiac workload. Bed rest- helps to decrease myocardial damage and the complications of myocarditis . Physical activity should be limited for a 6 month period ar atleast until heart size and function have returned to normal. For patients with moderate to severe dysfunction , cardiac function can be supported use of : Antibiotics Antiviral – interferon A Oral therapy with ACE inhibitors ( Captopril , Lisinopril ) Digoxin Diuretics Oxygen therapy Corticosteroids or immunosuppressents Heart transplant

13. NURSING MANAGEMENT:- The nurse assesses the patient’s temperature, tachycardia and other clinical manifestations to determine whether the disease is subsiding. The cardiovascular assessment focuses on signs and symptoms of heart failure and dysrhythmia . Patient with dysrhythmias should have continuous cardiac monitoring. Elastic compression stockings and passive and active exercises should be used.

14. COMPLICATION:- Atrial fibrillation Ventricular tachyarrhythmias Dilated cardiomyopathy Sudden cardiac death Multisystem organ failure

15. PREVENTION:- Prevention of infectious disease by means of appropriate immunizations ( eg , influenza, hapatitis ). Early and prompt treatment to decrease the incidence of myocarditis .