Chapter 37: Myocarditis o Inflammation of the myocardium can lead to cardiac dysfunction, which leads to dilated cardio myopathy.

Causes: Coxsackievirus A and B: Most Common Pharmacologic and chemicals factors Viruses, Bacteria, fungi Radiation therapy Autoimmune Signs and symptoms: Early signs and symptoms: Vague Early signs and symptoms of viral infection: fever, fatigue, malaise, myalgias, pharyngitis, dyspnea, lymphadenopathy, and n/v. Early Cardiac manifestations (appear 7-10 days): pleuritic chest pain with a pericardial friction rub and effusion because pericarditis often accompany myocarditis. Late Cardiac manifestations: development of HF and may include an S3 hear sound, crackles, jugular venous distention, syncope, peripheral edema, and angina. Diagnostic Tests: ECG: dysrhythmias and conduction disturbances may be present. Increased ESR and CRP Elevated Troponin Elevated viral Titers EMB (endomyocardial biopsy): A biopsy (removing small pieces of myocardial tissue percutaneously from the right ventricle) done during the initial 6 weeks of acute illness is most diagnostic because there is the period in which lymphocytic infiltration and myocyte damage indicative of myocarditis are present. Collaborative Care: Treatment usually consists of managing associated cardiac decompensation. And decreased Cardiac Output. Digoxin (Lanoxin): to treat ventricular failure because it improves myocardial contractility and reduces ventricular rate. Diruretics: may be used to reduce fluid volume and decrease preload If hypotension is not present: IV med-Nitroprusside (Nitropress), inamrinone (Inocor), milrinone ( Primacor): to reduce afterload and improve CO by decreasing systemic arterial resistance. Anticoagulants: for pts with low ejection fraction who are at risk for thrombus formation from blood stasis in the cardiac chambers. Prednisone, Azathiprine, Cyclosporine: to reduce myocardial inflammation and to prevent irreversible myocardial damage. O2 Bedrest and restricted activity. Semi-Fowlers position