Myocarditis also known as inflammatory cardiomyopathy, is inflammation of the heart muscle.

1. MANAGEMENT OF MYOCARDITIS
By
Dr. Muhammad Saifullah
DHQ Hospital, Faisalabad.

3. MYOCARDITIS:
Inflammation of the myocardium
is characterized by inflammatory cell
infiltrates, myocyte necrosis or
myocyte degeneration.

4. CAUSES
MYOCARDITI
S
INFECTIOUS
VIRAL
COXSACKIEVIRU
S
BACTERIAL
MYCOBACTERI
A
FUNGAL ASPERGILLUS
PROTOZOAL
TRYPANOSOMA
CRUZI
PARASITIC SCHISTOSOMA
IMMUNE-
MEDIATED AUTOANTIGENS
CHURG-STRAUSS
SYNDROME
HYPERSENSITIVIT
Y GRANULOMATOSIS
TOXIC ANTHRACYCLIN
ES

5. CLINICAL MANIFESTATIONS
• Ranges from asymptomatic or nonspecific
generalized illness to acute cardiogenic shock and
sudden death.
i. Fulminant Myocarditis…..
ii. Acute Myocarditis…..
iii. Chronic active Myocarditis…..

6. Fulminant Myocarditis
• Fever
• Respiratory distress
• Tachycardia
• Hypotension
• Gallop rhythm
• Cardiac murmur
CARDIOGENIC SHOCK
& HEART FAILURE
Acute/Chronic
Myocarditis
• Chest discomfort
• Fever
• Palpitations
• Easy fatigability
• Syncope
DILATED CARDIO-
MYOPATHY &
ARRYTHMIAS

7. INVESTIGATIONS
• Chest X-ray
• Electrocardiography
• Echocardiography
• Cardiac MRI….. Standard imaging modality
• Endomyocardial Biospy
• Isolation of the organism from stool, throat or blood

8. TREATMENT
1. COUNSELLING
• Nature of disease
• Treatment modalities
• Prognosis
• Complications

9. TREATMENT
2. SUPPORTIVE THERAPY
• Bed rest….. Prevents ventricular arrythmias
• Salt and Fluid restriction….. Prevents CCF

10. TREATMENT
2. SUPPORTIVE THERAPY
• Supplemental Oxygen for respiratory distress
• Correct anemia if present

11. TREATMENT
2. SUPPORTIVE THERAPY
• Diuretics….. Reduces preload
• Tepid sponging and anti-pyretics….. Reduces fever
related cardiac stress

12. TREATMENT
2. SUPPORTIVE THERAPY
• Ionotropic support….. Maintains blood pressure

13. TREATMENT
3. SPECIFIC ANTI-MICROBIAL THERAPY
• Not commonly used
• Used only if the causative organism is identified

14. TREATMENT
4. IMMUNO-RELATED THERAPY
Is seen to increase recovery in pediatric group as
compared to adults when combined with supportive
therapy
• Steroids
• Azathioprine
• Gamma-Globulins

15. PROGNOSIS
COMPLETE RECOVERY
• In approximately half of the patients within months
without any residual cardiac defect
INCOMPLETE RECOVERY
• In case of extensive myocardial disease when necrotic
tissue is replaced by scar tissue resulting in residual
defects