Myocarditis is an inflammatory process of the heart muscle that can be caused by viral, bacterial, fungal, or other infections. It causes symptoms ranging from fatigue and palpitations to chest pain and heart failure. Diagnosis involves EKG changes, elevated inflammatory markers, imaging, and endomyocardial biopsy. Treatment focuses on managing complications like heart failure through diuretics, antibiotics, bed rest, and modifying risk factors. Nursing care aims to reduce fever, maintain cardiac output, prevent fatigue, and provide education on lifestyle changes and symptom monitoring.

1. MYOCARDITIS Asst. Prof. Bhaumika Sharma
Chitwan Medical College

2. MYOCARDITIS
Myocarditis is an inflammatory process involving
the myocardium.

3. PATHOPHYSIOLOGY AND ETIOLOGY
1. Focal or diffuse inflammation of the myocardium; may
be acute or chronic.
2. May follow infectious process viral (particularly
coxsackie group B, and may develop after influenza A
or B, herpes simplex), bacterial, mycotic, parasitic,
protozoal, rickettsial, and spirochetal infections.
3. May be associated with chemotherapy (especially
doxorubicin [Adriamycin]) or immunosuppressive therapy.
4. Conditions, such as sarcoidosis and collagen diseases,
may lead to myocarditis.

4. CLINICAL MANIFESTATIONS
1. Symptoms depend on type of infection, degree
of myocardial damage, capacity of
myocardium to recover, and host resistance.
Can be acute or chronic and can occur at any
age. Symptoms may be minor and go
unnoticed.
Fatigue and dyspnea
Palpitations
Occasional precordial discomfort

5. CONTD.
2. Cardiac enlargement.
3. Abnormal heart sounds: murmur, S3 or S4, or
friction rubs.
4. Signs of heart failure (eg, pulsus alternans,
dyspnea, crackles).
5. Fever with tachycardia.

6. DIAGNOSTIC EVALUATION
1. Transient ECG changes ST segment flattened, T
wave inversion, conduction defects, extrasystoles,
supraventricular and ventricular ectopic beats
2. Elevated WBC count and sedimentation rate
3. Chest X-ray may show heart enlargement and
lung congestion

7. CONTD.
4. Elevated antibody titers (ASO titer as in
rheumatic fever)
5. Stool and throat cultures isolating bacteria or a
virus
6. Endomyocardial biopsy for definitive diagnosis
7. Echocardiogram defines size, structure, and
function of heart
8. Magnetic resonance imaging may be helpful to
determine structural alterations

8. MANAGEMENT
Treatment objectives are targeted toward
management of complications.
1. Diuretic and digoxin (Lanoxin) therapy for heart
failure and atrial fibrillation
2. Antidysrhythmic therapy (usually quinidine
[Quinaglute] or procainamide [Pronestyl])

9. CONTD.
3. Strict bed rest to promote healing of
damaged myocardium
4. Antimicrobial therapy if causative bacteria
is isolated
5. Anticoagulation therapy

10. COMPLICATIONS
Heart failure
Cardiomyopathy

11. NURSING ASSESSMENT
1. Assess for fatigue, palpitations, fever,
dyspnea, and chest pain.
2. Auscultate heart sounds.
3. Evaluate history for precipitating factors.

12. NURSING DIAGNOSES
1.Hyperthermia related to inflammatory/infectious
process
2.Decreased Cardiac Output related to decreased
cardiac contractility and dysrhythmias
3.Activity Intolerance related to impaired cardiac
performance and febrile illness

13. REDUCING FEVER
1. Administer antipyretics as directed.
2. Check temperature every 4 hours.
3. Administer antibiotics as directed.

14. MAINTAINING CARDIAC OUTPUT
1. Evaluate for clinical evidence that disease is
subsiding—monitor pulse, auscultate for abnormal
heart sounds (murmur or change in existing murmur),
check temperature, auscultate lung fields, monitor
respirations.
2. Record daily intake and output.
3. Record daily weight.

15. CONTD.
4. Check for peripheral edema.
5. Elevate head of bed, if necessary, to enhance
respiration.
6. Treat the symptoms of heart failure as
prescribed.
7. Evaluate patient's pulse and apical rate for signs
of tachycardia and gallop rhythm indications
that heart failure is recurring.

16. 8. Evaluate for evidence of dysrhythmias
patients with myocarditis are prone to develop
dysrhythmias.

17. REDUCING FATIGUE
Ensure bed rest to reduce heart rate, stroke volume,
BP, and heart contractility; also helps to decrease
residual damage and complications of myocarditis,
and promotes healing.
Prolonged bed rest may be required until there is
reduction in heart size and improvement of function.
Provide diversional activities for patient.

18. CONTD.
Allow patient to use bedside commode rather than
bedpan (reduces cardiovascular workload).
Discuss with patient activities that can be continued
after discharge.
Discuss the need to modify activities in the immediate
future.
Explore with patient lifestyle modifications and discuss
adequacy of self-concept.

19. PATIENT EDUCATION AND HEALTH MAINTENANCE
Instruct patient as follows:
There is usually some residual heart enlargement; physical activity may be
slowly increased; begin with chair rest for increasing periods; follow with
walking in the room and then outdoors.
Report any symptom involving rapidly beating heart.
Avoid competitive sports, alcohol, and other myocardial toxins (doxorubicin
[Adriamycin]).
Pregnancy is not advisable for women with cardiomyopathies associated with
myocarditis.
Prevent infectious diseases with appropriate immunizations.
Encourage family to support patient and learn about the illness.

20. EVALUATION: EXPECTED OUTCOMES
Afebrile
BP and heart rate stable; no dysrhythmias
noted
Maintains bed rest

21. Any queries?