myocardium is the middle muscular layer of heart chest pain, shortness of breath, arrythmia, Coxsackie virus is the main cause

1. MYOCARDITIS
Nursing Instructor
Safoora Qureshi
CON, PIMS

2. Myocardium
• Middle, thickest layer
• Have involuntary control
• Composed of specialized
• Cardiac muscles
• Responsible for heart pumping
• Characteristics
• Automaticity
• Contractility
• Rhythmicity

3. Myocarditis
• Myocarditis is a focal and defuse inflammation of myocardium.
• Myocarditis can cause
• Chest pain,
• Shortness of breath
• Arrhythmias).
• Myocarditis is an inflammatory disease of the myocardium caused
by different infectious and noninfectious triggers
• The inflammation can reduce the heart's ability to pump blood
• Clots can form in the heart, leading to a stroke or heart attack.

4. Myocarditis

5. Pathophysiology
When myocardium become infected;
• The causative agents invade the myocytes and cause cellular damage
and necrosis
• The immune response is activated and cytokines and oxygen-free
radicals are released
• As the infection progresses, autoimmune response is activated
resulted in further destruction of myocytes
• Myocarditis result in cardiac dysfunction and developed dilated
cardiomyopathy

6. Viral infection
Inflammation & injury
Myocardial contractility
CHF
Sympathetic tone
Cardiac output
Heart enlarges: LVEDV
LAP
Pulm. edema
Scaring
Dysrhythmia
LAP:
Left atrial
pressure
LVEDV:
Left ventricular
end diastolic
Volumes
Pathophysiology of Myocarditis

7. Causes
• Viruses
• Coxsackie virus ,
• Influenza virus,
• Covid-19
• Bacteria,
• Fungi,
• parasite,
• Radiation,
• Pharmacologic / chemical factors
• Autoimmune diseases such as
• Lupus, Polymyositis, sarcoidosis
• May associated with
• acute pericarditis

8. Clinical manifestation
Early Systemic Manifestation of Viral illness:
• Fever, fatigue, malaise, myalgia, Pharyngitis, dyspnea, lymphadenopathy, nausea and vomiting
Early Cardiac Manifestation; appears after 7 to 10 days of viral illness
• Chest pain with pericardial friction rub and effusion
• Shortness of breath at rest or during activity.
Late cardiac Sign:
• Sign of heart failure/ CHF
• Arrythmias/ rapid or irregular heartbeat
• S3 heart sound
• Crackers
• Syncope/light-headed ness
• Peripheral edema
• Angina
• Juglar vein distension

9. Types
Acute myocarditis
• Relatively recent fast onset of myocarditis
• Usually caused by a viral infection.
• Develop suddenly, and symptoms may resolve rapidly as well.
Chronic myocarditis
• Chronic myocarditis is
• when it takes longer than usual to treat the disease or
• when symptoms reappear after experiencing the condition
• If acute myocarditis does not disappear quickly or
• If myocarditis symptoms reappear later an episode of acute
myocarditis

10. Lymphocytic myocarditis
• Lymphocytic myocarditis is a rare form of myocarditis that can
result in hospitalization for acute care
• It occurs when white blood cells (lymphocytes) enter and cause
inflammation of the heart muscle.
• This condition can occur after a viral infection.

11. Diagnosis
• ECG:
• Show non-specific changes, may associated with acute pericarditis,
dysrhythmias and conduction disturbance
• Lab:
• ESR, CRP level raised
• Lymphocytosis, mild to moderate level
• Myocardial Markers, troponin level increase
• Viral titers level elevated ( 8 to 10 days of illness)
EMB (endomyocardial Biopsy); confirm myocarditis in early 6 wks
MRI: evaluate cardiac function

12. ECG changes in Myocarditis
• ST-T wave changes, Q waves, QT interval prolongation, QRS
prolongation, low voltage, atrioventricular block (AVB), bundle
branch block (BBB) and ventricular tachycardia

13. Collaborative Care
 Specific treatment
for myocarditis to manage cardiac decompensation
• Digoxin:
• to treat ventricular failure, by improving contractility and reducing ventricular
rate
• Diuretics:
• to reduce fluid volume and decrees Preload
• Nitroprusside, Primacore;
• to reduce afterload and improve CO by decreasing SVR
• Anti-coagulant Therapy:
• indicated in patients with low ejection friction, at risk for thrombus formation
from blood stasis in chambers

14. Immunosuppressive therapy:
• Prednisolone:
• To reduce myocardial inflammation
• To prevent irreversible myocardial damage
• Intravenous Immunoglobulin (IVIG):
• To treat myocarditis, use on experimental basis
• To proved left ventricular function
• To improve survival
• Anti-viral Agents:
• To treat acute myocarditis
Supportive Therapy:
• Oxygen therapy
• Bed rest
• Restricted activities
• Intra-aortic Balloon Pump Therapy;
• a form of mechanical therapeutic device
• Use in case of severe HF

16. Nursing management
• Assess the patient for sign and symptoms of HF such as;
• SOB, palpitation, tachycardia, confusion, fainting etc
• Systemic organ assessment
• Take measures to decrease cardiac work load
• Semi-Fowler’s position
• Spacing of activity and rest period
• Provision of calm and quiet environment
• Administration of prescribe medication that increase heart contractility
• Strict monitoring of cardiac function
• Keep the patient and family well informed about therapeutic measures
• Immunocompromise patient should be
• Monitor for complications
• Provision of safe clean environment
• Take infection control measures