MYOCARDITIS

Subtitle

MYOCARDITIS
ois an inflammation of

the myocardium, the thick muscular layer making up the major portion of your heart.

MYOCARDITIS
Inflammation may involve the myocytes, interstitium, vascular elements &/or pericardiumelements &/or pericardium
Can cause heart dilation, thrombi on the heart wall (mural thrombi), infiltration of circulating blood cells around the coronary vessels and between muscle fibers themselves.

Characterized by isolated pockets of inflamed & necrotic myocardial cells.

Myocardial involvement may be local or diffuse, but the myocardial lesions are generally randomly distributed in the in the heart & thus the clinical consequences are dependent on the size & number of lesions and the location of the lesions; a small single lesion residing in the conductive tissue may result in a fatal arrhythmia. May be chronic or acute.

RISK FACTORS
1.

2. 3. 4. 5. 6.

AGE GENDER REGION ACUTE SYSTEMIC INFECTIONS SUCH AS RHEUMATIC FEVE VIRAL INFECTION PTS RECEIVING IMMUNOSUPPRESSIVE THERAPY

ETIOLOGY
VIRAL [COXSACKIEVIRUS A OR B, ECHOVIRUS, HUMAN IMMUNODEFICIENCY VIRUS] BACTERIAL [DIPHTERIA] FUNGAL [ASPERGILLOSIS] PROTOZOAN [TOXOPLASMOSIS, TRYPANOSOMA] ROUNDWORM [TRICHINOSIS]

TOXIC ETIOLOGY
DRUGS THAT MAY CAUSE HYPERSENSITIVITY REACTIONS (CLOZAPINE, PENICILLIN, AMPICILLIN, HYDROCHLOROTHIAZIDE, METHYLDOPA, AND SULFONAMIDE)
MEDICATIONS THAT MAY EXERT A DIRECT CYTOTOXIC EFFECT ON THE HEART. (EG: LITHIUM, DOXORUBICIN, COCAINE, NUMEROUS CATECHOLAMINES, ACETAMINOPHEN)

ETIOLOGY
Myocarditis also sometimes occurs when a person is exposed to:
CERTAIN CHEMICALS These may include substance such as arsenic and hydrocarbons. MEDICATIONS THAT MAY CAUSE ALLERGIC OR TOXIC REACTION

These include antibiotics such as penicillin and sulfonamide drugs, as well as some illegal substances such as cocaine

ETIOLOGY
SYTEMIC DISEASE
INCLUDES LUPUS, OTHER CONNECTIVE TISSUE DISORDER, INFLAMMATION OF BLOOD VESSELS (VASCULITIS), AND RARE INFLAMMATORY CONDITIONS SUCH AS WEGENERS GRANULOMATOSIS.

SIGNS AND SYMPTOMS

DEPENDS ON THE TYPE OF INFECTION, THE DEGREE OF MYOCARDIAL DAMAGE, & THE CAPACITY OF THE MYOCARDIUM TO RECOVER.
MAY BE ASYMPTOMATIC & THE INFECTION RESOLVES ON ITS OWN. SOMETIMES MILD TO MODERATE SYMPTOMS (Fatigue, dyspnea, palpitations, occassional discomfort in the chest & upper abdomen)

DIAGNOSTIC TEST
Assessment of the patient may reveal no abnormalities ; as a result,the entire illness goes unrecognized.

DIAGNOSTIC TEST
A PERCUTANEOUS ENDOMYOCARDIAL BIOPSY DURING THE FIRST 6 WEEKS OF INFLAMMATION IS THE PREFERRED DIAGNOSTIC TEST FOR MYOCARDITIS, ALTHOUGH IT IS POSITIVE ONLY ABOUT 30% OF THE TIME. MRI AND GALLIUM-67 SCANNING ARE HELPFUL.

AN ELECTROCARDIOGRAM (ECG) SHOWS DYSRHYTHMIAS, COMMONLY SINUS TACHYCARDIA.

PATHOPHYSIOLOGY

THERAPEUTIC INTERVENTION
REDUCING HEARTS WORKLOAD
INCLUDE BEDREST AND LIMITED ACTIVITY ADMINISTER OXYGEN FOR HYPOXIA.

EXERCISE SHOULD BE AVOIDED (R: IT INCREASES MYOCARDIAL INFLAMMATION)

TX IS AIMED AT THE CAUSE (IF KNOWN) ANTIBIOTICS FOR BACTERIAL INFECTIONS THE USE OF ALCOHOL AND TOBACCO SHOULD BE AVOIDED.

THERAPEUTIC INTERVENTION
HEART FAILURE IS TREATED WITH MEDICATION TO STRENGTHEN THE HEARTS CONTRACTILITY AND SLOW THE HEARTS RATE, WHICH REDUCES THE HEARTS WORKLOAD AND OXYGEN NEEDS.
WITH MYOCARDITIS, THE HEART IS SENSITIVE TO DIGOXIN, WHICH MAY BE USED TO TREAT HEART FAILURE, AND TOXICITY MAY OCCUR EVEN WITH SMALL DOSES. THE PATIENT SHOULD BE MONITORED CLOSELY FOR SIGNS OF DIGOXIN TOXICITY, WHICH MAY INCLUDE ANOREXIA, NAUSEA, VOMITING, BRADYCARDIA, DYSRHYTHMIAS, OR MALAISE. THE USE OF IMMUNOSUPPRESSIVE THERAPY IS BEING INVESTIGATED AND MAY RESULT IN NEW TREATMENT OPTIONS IN THE FUTURE.

NURSING INTERVENTION
RECENT ILLNESSES, TOXIN EXPOSURE, CARDIAC DISEASES, ACTIVITY TOLERANCE, AND CURRENT MEDICATIONS ARE DOCUMENTED.
VITAL SIGNS AND SIGNS OF HEART FAILURE, SUCH AS JUGULAR VEIN DISTENTION, PERIPHERAL EDEMA, CRACKLES, AND DYSPNEA ARE NOTED. NURSING CARE IS AIMED AT THE PATIENTS MAINTENANCE OF NORMAL CARDIAC FUNCTION BY MONITORING VITAL SIGNS AND SYMPTOMS AND ADMINISTERING MEDICATIONS AS ORDERED.

NURSING INTERVENTION
INTERVENTIONS TO REDUCE FATIGUE INCLUDE PROVIDING ASSISTANCE AS NEEDED, HAVING FREQUENT REST PERIODS, AND TEACHING ENERGY CONSERVATION METHODS. REDUCING THE PATIENTS ANXIETY AND INCREASING THE PATIENTS KNOWLEDGE CAN BE ACHIEVED THROUGH TEACHING ABOUT THE DISEASE. DETERMINING DIVERSIONAL ACTIVITIES WITH THE PATIENT FOR TIMES WHEN ACTIVITY IS RESTRICTED FURTHER REDUCES ANXIETY.

NURSING INTERVENTION
ASSESS THE PTS TEMPERATURE TO DETERMINE WHETHER THE DISEASE IS SUBSIDING

ELASTIC COMPRESSION STOCKINGS AND PASSIVE AND ACTIVE EXERCISES SHOULD BE USED (R: EMBOLIZATION FROM VENOUS THROMBOSIS AND MURAL THROMBI CAN OCCUR)