For 2nd year year B.Sc. Nursing students.

1. MYOCARDITIS
Presented By:
Mr. Nandish.S
Asso. Professor
Mandya Institute of Nursing Sciences

3. DEFINITION :
 It is a focal or diffuse inflammation of the myocardium.
 It is the inflammatory process involving the myocardium, can cause
heart dilation, thrombi on heart wall, infiltration of circulating blood
cells & degeneration of muscle fibres.
 It is an inflammation of heart muscle (myocardium). It can affect
electrical conductive system of heart reducing heart’s ability to pump
blood.

4. ETIOLOGY & RISK FACTORS :
1. Infections
 Viral : Coxsackievirus A and B, Echovirus, Influenza A and B,
Mumps virus, Adenovirus.
 Bacterial
 Rickettsial
 Fungal
 Parasitic
 Spirochetal
 Protozoal (Chagas disease) infection.
2. Systemic Lupus Erythematosus
3. Immunosuppressive Therapy
Continued …..

5. 4. Rheumatic Fever
5. Autoimmune disorder
6. Infective Endocarditis
7. Radiation Therapy
8. Side effects of Medication – Penicillin, Sulfonamides
9. Idiopathic

6. PATHOPHYSIOLOGY :
Due to infection (viral or bacterial)
Activation of macrophages & Lymphocytes
Release of cytokinase
Activation of fibroblast & remodelling
Increased collagen synthesis
Fibrosis
Dilated & Ischemic cardiomyopathy

7. CLINICAL FEATURES :
 Features are variable ranging from without any overt manifestations
to severe heart involvement or sudden death.
 Fever
 Fatigue / Malaise
 Myalgia
 Dyspnoea
 Lymphadenopathy
 Nausea & Vomiting
 Syncope
Continued …

8. Cardiac signs :
They appear 7 to 10 days after cardiac infections.
 Pericardial chest pain
 S3 sound will heard during auscultation
 Crackles
 Jugular venous distension
 Peripheral Oedema
 Congestive Heart Failure.

9. DIAGNOSTIC STUDIES :
 History collection & Physical Examination
 ECG : ST segment abnormalities
 Chest X- Ray
 CBC : Leukocytosis
 Increased ESR & CRP
 Cardiac Markers : increased Creatine Kinase
 Endomyocardial Biopsy (EMB)
 Echocardiography
 Cardiac MRI

13. MANAGEMENT :
Medical :
• Corticosteroids : prednisone
• Digoxin
• Oxygen therapy
• Immunosuppressive therapy : Azathioprine, cyclosporine
• Antibiotics
• Intravenous immunoglobulin
• Antiviral drugs – Ribavirin, ά Inferon.

14. In severe cases,
Ventricular Assist Device (VAD)
 Ventricular Assist Device, they are mechanical pumps that help pump
blood from lower chambers of heart (ventricles) to rest of the body.
 They are used in people who have weakened heart or heart failure.
This treatment may be used to allow the heart to recover while
waiting for the other treatment.

16. Intra Aortic Balloon Pump (IABP)
 It is a device that helps your heart to pump more blood. It is
recommended when your heart is not pumping enough blood through
circulatory system.
 A catheter (balloon attached) is inserted into an artery in your leg.
Use imaging technology to guide balloon & aorta to aorta.
 IABP is attached to a machine that tells balloon when to inflate &
deflate.
 It helps heart to increase the blood flow & decrease the workload.

19. Extracorporeal Membrane Oxygenation (ECMO)
 It is also known as extracorporeal Life support. Extra corporeal means
outside the body.
 This will help a person whose lungs and heart are not functioning
properly.
 During this treatment, blood flows out of your body through a tube in
the large blood vessel (in chest, in groin or in neck). A pump pushes
your blood through tubes that carry it to a machine. It adds oxygen and
removes carbon dioxide from blood. Then the machine pumps your
blood back into your body.
 Since ECMO is a complex set up, it is used only in extreme cases.

22. Nursing Management :
 Pain, Acute in chest related to infection & inflammation of
myocardium.
 Decreased cardiac output related to left ventricular incompetency.
 Activity intolerance related to increased oxygen demand and
insufficient oxygen supply.
 Risk for ineffective tissue perfusion, related to decreased cardiac
output.
 Anxiety related to disease condition and treatment.

23. THANK YOU