Myocarditis

--is an inflammatory process involving the myocardium, can cause dilation, thrombi on the heart wall (mural thrombi), infiltration of circulating blood cells around the coronary vessels and between the muscle fibers, a degeneration of the muscle fibers themselves.

Clinical Manifestation Assessment

--assess for chest pain --assess for difficulty of breathing --assess for cardiac enlargement --assess for faint heart sounds, gallop rhythm and systolic murmurs **Patients may be asymptomatic with an infection that resolves on its own **May develop mild to moderate symptoms such as: --fatigue --dyspnea --palpitations --discomfort in chest and upper abdomen --flulike symptoms and tachycardia (most common) --pericardial friction rub may be heard if associated w/ pericarditis --pulsus alterns may be present --CHF symptoms may develop

Diagnostic Findings

Pathophysiology An infectious organism directly invades the myocardium Triggers an autoimmune, cellular or humoral reaction Local and systemic immunological inflammation quickly ensues Inflammation leads to hypertrophy, fibrosis and inflammatory changes of the myocardium and conduction system Heart muscle weakens and contractility is reduced Heart muscles dilated Pinpoint hemorrhages may develop

**Electrical Testing (EKG)- can suggest irritation of the heart muscle **Cardiac MRI with contrast- can guide clinicians for endocardial biopsies **Biopsy done in the setting of Angiography **Elevated C-reactive protein (CRP) and/or Erythrocyte sedimentation rate (ESR) **Increased IgM (serology)

Medications
**Penicillin for hemolytic streptococci **ACE Inhibitors relax the blood vessels in the heart and help blood flow more easily **Beta-blockers are avoided because it decreases the strength of ventricular contraction (have a negative inotropic effect)

Nursing Intervention
1. 2. 3. 4. 5. 6. Monitor for digitalis toxicity (dysrythmia, anorexia, N/V, bradycardia, headache, malaise) Apply and instruct pt. and family in use of elastic stockings and active and passive exercises Instruct pt. to increase physical activity slowly and report symptoms of rapid heart upon increasing activity Instruct pt. to avoid competitive sports and alcohol Promote bed rest Continuous cardiac monitoring