MYOCARDITIS

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MYOCARDITIS
Myocarditis is an inflammatory process involving 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.  Most patients with mild symptoms recover completely.
Other patients may develop cardiomyopathy and heart failure.
Causes
Myocarditis usually results from:
v Viral, bacterial, mycotic, parasitic, protozoal, or spirochetal infection. It also may occur in patients after
v Acute systemic infections such as rheumatic fever
v Allergic reaction to pharmacologic agents
Pathophysiology
Myocarditis usually results from a viral, bacterial, mycotic, parasitic, protozoal, or spirochetal infection. It also may occur in patients after acute systemic infections such as rheumatic fever, in those receiving immunosuppressive therapy, or in those with infective endocarditis. Myocarditis may result from an allergic reaction to pharmacologic agents used in the treatment of other diseases. It may begin in one small area and then spread throughout the myocardium. The degree of myocardial involvement determines the degree of hemodynamic effect and resulting signs and symptoms. It is theorized that dilated cardiomyopathy is a latent, manifestation of myocarditis.
Clinical Manifestations
v The patient may be asymptomatic and the infection resolve on its own.
v Fatigue
v Dyspnea
v Palpitations
v Discomfort in the chest and upper abdomen
v Arrhythmias
v Systolic murmur
v Faint heart sounds
Complications
v Cardiac death
v Congestive heart failure
Assessment and Diagnostic Findings
v Cardiac catheterization: demonstrating normal coronary arteries.
v Echocardiogram
v Electrocardiogram
Prevention
Prevention of infectious diseases by means of appropriate immunizations(e.g. influenza, hepatitis) and early treatment of infection.
Medical Management
v The patient receives specific treatment for the underlying cause if it is known (e.g., penicillin for hemolytic streptococci) and is placed on bed rest to decrease the cardiac workload.
v Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are not to be used during the acute phase or if the patient develops heart failure, because these medications can cause further myocardial damage.
Nursing Management
v Assess the patient’s temperature to determine whether the disease is subsiding.
v  Assess for signs and symptoms of heart failure and dysrhythmia.

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