MYOCARDITIS DEFINITION Myocarditis is the inflammation of the

MYOCARDITIS

DEFINITION Myocarditis is the inflammation of the middle layer of the heart wall. It is usually caused by a viral infection. A severe case can weaken the heart, which can lead to heart failure, abnormal heartbeat and sudden death.

CAUSES Viral infection is the most common cause of myocarditis.

Some things that can cause myocarditis include: Bacteria Parasite Fungi

Medications or illegal drugs that might cause an allergic or toxic reaction. These include drugs used to treat cancer; antibiotics, such as penicillin and sulfonamide drugs; some anti-seizure medications; and some illegal substances, such as cocaine. Chemicals or radiation. Exposure to certain chemicals, such as carbon monoxide, and radiation can sometimes cause myocarditis. Other diseases. These include disorders such as lupus, Wegener's granulomatosis, giant cell arteritis and Takayasu's arteritis.

Symptoms Common myocarditis signs and symptoms include: Chest pain Rapid or abnormal heart rhythms (arrhythmias) Shortness of breath, at rest or during physical activity Fluid retention with swelling of your legs, ankles and feet Fatigue

Other signs and symptoms of a viral infection, such as a headache, body aches, joint pain, fever, a sore throat or diarrhea

Diagnosis Electrocardiogram (ECG). This noninvasive test shows your heart's electrical patterns and can detect abnormal rhythms. Chest X-ray. An X-ray image shows the size and shape of your heart, as well as whether you have fluid in or around the heart that might indicate heart failure.

MRI. Cardiac MRI will show your heart's size, shape and structure. This test can show signs of inflammation of the heart muscle. Echocardiogram. Sound waves create moving images of the beating heart. An echocardiogram might detect enlargement of your heart, poor pumping function, valve problems, a clot within the heart or fluid around your heart.

Blood tests. These measure white and red blood cell counts, as well as levels of certain enzymes that indicate damage to your heart muscle. Blood tests can also detect antibodies against viruses and other organisms that might indicate a myocarditis-related infection. Cardiac catheterization and endomyocardial biopsy. A small tube (catheter) is inserted into a vein in your leg or neck and threaded into your heart. In some cases, doctors use a special instrument to remove a tiny sample of heart muscle tissue (biopsy) for analysis in the lab to check for inflammation or infection.

TREATMENT Angiotensin-converting enzyme (ACE) inhibitors. These medications, such as enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil) and ramipril (Altace), relax the blood vessels in your heart and help blood flow more easily. Angiotensin II receptor blockers (ARBs). These medications, such as losartan (Cozaar) and valsartan (Diovan), relax the blood vessels in your heart and help blood flow more easily.

Beta blockers, such as metoprolol (Lopressor, Toprol-XL), bisoprolol and carvedilol (Coreg), work in multiple ways to treat heart failure and help control arrhythmias. Diuretics. These medications, such as furosemide (Lasix), relieve sodium and fluid retention.

NURSING INTERVENTION Assess complaints of chest pain, observe the factors that aggravate. Notice the nonverbal cues of discomfort, for example, lay in silence / restlessness, muscle tension, crying. Rational: the pain is worse on inspiration, move or lie down and relieved by sitting up straight / bent.

Provide a quiet environment and comfort measures such as: change of position, rub his back, use warm compresses / cold, emotional support. Rationale: These measures can reduce the physical and emotional discomfort of the patient.

Provide appropriate entertainment activities. Rational: to redirect attention, provide distraction in the level of individual activity

Collaboration provision of drugs as indicated (nonsteroidal agents: aspirin, Indocin; antipyretic; steroids). Rational: to relieve pain, reduce the inflammatory response, reduce fever; steroids given for more severe symptoms.

Collaboration supplemental oxygen administration as indicated. Rational: maximizing the availability of oxygen to reduce the heart's workload.

Nursing Diagnosis for Myocarditis Pain related to inflammation of the myocardium, systemic effects of infection, tissue ischemia. Activity Intolerance related to inflammation and degeneration of myocardial muscle cells, decreased cardiac output.

Risks for Decrease Cardiac Output related to degeneration of heart muscle, decreased / constricting ventricular function. Knowledge Deficit : about the condition, treatment plan related to less knowledge / memory.

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