2. Myocarditis is a focal or diffuse inflammation of the
myocardium. - Lewis's, Medical Surgical
Myocarditis is an inflammation of the myocardial
wall frequently the inflammation is not limited to the
myocardium but extends to the pericardium.
-Joyce M Black
Myocarditis, an inflammatory process involving the
myocardium, 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.
Brunner, Medical Surgical Nursing
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4. Causative organism enters the body through different
route
It invades the cardiac myocytes and causes cellular
damage and necrosis
The immune system activated and, cytokines and
oxygen free radicals are released
Further autoimmune activated resulting in destruction
of myocytes
This outcome is commonly dilated cardiomyopathy
and heart failure
4
5. Present with the history of recent upper respiratory or
GI tract infection
Fever, Fatigue, malaise, myalgia
Dyspnea, Syncope, palpitations
Pharyngitis, lymphadenopathy
Nausea and vomiting
Chest pain as sharp, stabbing precordial pain
Tachycardia, abnormal heart sounds, murmurs,
gallops
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6. History and physical examination
ECG: bundle branch block, or complete AV heart
block, ST segment elevation or T wave flattening
Leukocytosis, atypical lymphocytes, increased ESR
and CRP
Myocardial markers (elevated troponin) and viral
titers
Endomyocardial biopsy
Echocardiography and MRI
6
7. Non pharmacological management:
Bed rest
Supplemental oxygen therapy
Holter monitoring
Pharmacological management
No specific management , only management of symptoms
Digoxin (use cautiously )
Nitroprussive, Inamrinone and Milrinone
Anticoagulation
Immunosuppressive therapy: prednisone, azathioprine, and
cyclosporine
Intravenous immunoglobulin:
Antiviral agents: ribavirin, alpha interferon
Antipyretics
Diuretics
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8. Pericarditis is inflammation of the pericardium and it
may be either acute or chronic.
-Black M Joyce medical surgical
Pericarditis is a condition caused by inflammation of
the pericardial sac.
Lewis Medical surgical
Pericarditis refers to an inflammation of the
pericardium, which is the membranous sac involving
the heart.
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11. 1) Acute pericarditis: is a syndrome resulting from
inflammation of the parietal and visceral pericardium.
Under normal conditions the pericardial sac contains
about 50 ml of clear , serous fluid. Volumes from 100-
3000 ml of serofibrinous exudate can accumulate with
pericarditis.
2) Chronic constrictive pericarditis: it results from
scarring with consequent loss of elasticity of the
pericardial sac. It often begins with an acute pericarditis
and is characterized by fibrin deposition with a
clinically undetected pericardial effusion.
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15. History and physical examination
ECG-PR segment depression, ST segment elevation
and T wave flattening and inversion
Chest X ray, Echocardiography
Doppler imaging
CT/MRI
Increased CRP and ESR
Pericardial biopsy
15
16. Analgesic medication: aspirin, ibuprofen
Treat underlying cause with broad sprectorm antibiotics.
Eg. Ceftriaxone, penicillin
NSAIDs ( brufen, Flexon) to reduce pain
Morphine for severe pain
Symptomatic treatment is done with bed rest
Corticosteroids: prednisone
Colchicine
Pericardiocentesis: it is a procedure in which some
pericardial fluid is removed.
Pericardiectomy: complete resection of pericardium
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17. Pericardial effusion: it is an accumulation of
excess fluid in the pericardium.
Cardiac tamponade: it develops as the
pericardial effusion increases in volume,
causing an increase in intrapericardial
pressure.
Cardiac failure
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