Myocarditis is an inflammation of the heart muscle that can cause thickening and swelling of the heart. It has infectious causes like viruses and bacteria, as well as non-infectious causes like drugs. Symptoms range from mild fatigue to life-threatening arrhythmias or heart failure. Diagnosis involves EKG, blood tests, imaging and endomyocardial biopsy. Treatment focuses on supporting heart function, reducing workload, and addressing the underlying cause. Complications can include arrhythmias, cardiomyopathy and sudden cardiac death if not properly managed.

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

2. LAYERS OF THE HEART

4. 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.

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

7. 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.

8. 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)

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

11. PATHOPHYSIOLOGY

12. 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.

14. DIAGNOSTIC EVALUTION
• History collection.
• Physical examination :-A physical examination may
show no abnormalities, or may reveal the following: -
I. Abnormal heartbeat
II. Fever
III. Tachycardia
IV. 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.

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

16. 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 :
i. Antibiotics
ii. Antiviral – interferon A
iii. Oral therapy with ACE inhibitors (Captopril, Lisinopril)
iv. Digoxin
v. Diuretics
vi. Oxygen therapy
vii. Corticosteroids or immunosuppressents
• Heart transplant

17. 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.

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

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