Myocarditis is an inflammatory disease of the myocardium caused by various infectious and non-infectious triggers, leading to symptoms such as chest pain and shortness of breath. It can result in significant complications like heart failure and arrhythmias, with diagnoses relying on ECG changes and lab tests. Treatment involves managing cardiac decompensation through medications, immunosuppressive therapy, and supportive care, while nursing management focuses on monitoring and reducing cardiac workload.

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