MYOCARDITIS

Group 2
INTRODUCTION

 Causative agent
 viral infection,such as parvovirus B19, less commonly non-
viral pathogens such as Borreliaburgdorferi (Lyme disease) or
Trypanosomacruzi, or as a hypersensitivity response to drugs.
DEFINITION

 The definition of myocarditis varies, but the central

feature is an infection of the heart, with an inflammatory
infiltrate, and damage to the heart muscle, without the
blockage of coronary arteries that define a heart attack (
myocardial infarction) or other common non-infectious
causes. Myocarditis may or may not include death (
necrosis) of heart tissue. It may include
dilated cardiomyopathy.
 Myocarditis is often an autoimmune reaction.
Streptococcal M protein and coxsackievirus B have
regions (epitopes) that are immunologically similar to
cardiac myosin. After the virus is gone, the immune
system may attack cardiac myosin. The consequences of
myocarditis thus also vary widely. It can cause a mild
disease without any symptoms that resolves itself, or it
may cause chest pain, heart failure, or sudden death.
ANATOMY AND PHYSIOLOGY
HUMAN HEART

 Hollow, pear-shaped organ about the size of a fist

 Made of muscle that rhythmically contracts, or beats,
pumping blood throughout the body.
 Oxygen-poor blood from the body enters the heart from
two large blood vessels, the inferior vena cava and the
superior vena cava, and collects in the right atrium
 Blood returning from the lungs to the heart collects in
the left atrium.
STRUCTURE OF THE HEART

 Heart Valves
 Four valves within the heart prevent blood from flowing
backward in the heart. The valves open easily in the direction
of blood flow, but when blood pushes against the valves in
the opposite direction, the valves close.
 Two valves, known as atrioventricular valves, are located
between the atria and ventricles. The right atrioventricular
valve is formed from three flaps of tissue and is called the
tricuspid valve. The left atrioventricular valve has two flaps
and is called the bicuspid or mitral valve
 The other two heart valves are located between the
ventricles and arteries. They are called semilunar valves
because they each consist of three half-moon-shaped
flaps of tissue. The right semilunar valve, between the
right ventricle and pulmonary artery, is also called the
pulmonary valve. The left semilunar valve, between the
left ventricle and aorta, is also called the aortic valve.
MYOCARDIUM

 Muscle tissue, known as myocardium or cardiac muscle,

wraps around a scaffolding of tough connective tissue to
form the walls of the heart’s chambers. The atria, the
receiving chambers of the heart, have relatively thin
walls compared to the ventricles, the pumping chambers.
The left ventricle has the thickest walls—nearly 1 cm
(0.5 in) thick in an adult—because it must work the
hardest to propel blood to the farthest reaches of the
body.
PERICARDIUM

 A tough, double-layered sac known as the pericardium

surrounds the heart. The inner layer of the pericardium,
known as the epicardium, rests directly on top of the
heart muscle. The outer layer of the pericardium attaches
to the breastbone and other structures in the chest cavity
and helps hold the heart in place. Between the two layers
of the pericardium is a thin space filled with a watery
fluid that helps prevent these layers from rubbing against
each other when the heart beats.
ENDOCARDIUM

 The inner surfaces of the heart’s chambers are lined with

a thin sheet of shiny, white tissue known as the
endocardium. The same type of tissue, more broadly
referred to as endothelium, also lines the body’s blood
vessels, forming one continuous lining throughout the
circulatory system. This lining helps blood flow
smoothly and prevents blood clots from forming inside
the circulatory system.
CORONARY ARTERIES
 The heart is nourished not by the blood passing through its
chambers but by a specialized network of blood vessels.
Known as the coronary arteries, these blood vessels encircle
the heart like a crown. About 5 percent of the blood pumped
to the body enters the coronary arteries, which branch from
the aorta just above where it emerges from the left ventricle.
Three main coronary arteries—the right, the left circumflex,
and the left anterior descending—nourish different regions of
the heart muscle. From these three arteries arise smaller
branches that enter the muscular walls of the heart to provide
a constant supply of oxygen and nutrients. Veins running
through the heart muscle converge to form a large channel
called the coronary sinus, which returns blood to the right
atrium.
FUNCTION OF THE HEART

 CARDIAC CYCLE
 The sequence of events from the beginning of one heartbeat
to the beginning of the next is called the cardiac cycle
 The cardiac cycle has two phases: diastole, when the heart’s
chambers are relaxed, and systole, when the chambers
contract to move blood. During the systolic phase, the atria
contract first, followed by contraction of the ventricles. This
sequential contraction ensures efficient movement of blood
from atria to ventricles and then into the arteries. If the atria
and ventricles contracted simultaneously, the heart would not
be able to move as much blood with each beat.
 During diastole, both atria and ventricles are relaxed, and the
atrioventricular valves are open. Blood pours from the veins
into the atria, and from there into the ventricles
 Next, the ventricles contract, forcing blood out through the
semilunar valves and into the arteries, and the atrioventricular
valves close to prevent blood from flowing back into the
atria. As pressure rises in the arteries, the semilunar valves
snap shut to prevent blood from flowing back into the
ventricles. Diastole then begins again as the heart muscle
relaxes—the atria first, followed by the ventricles—and blood
begins to pour into the heart once more.
CARDIAC OUTPUT
 The amount of blood pumped by each ventricle in one
minute.
 Cardiac output is equal to the heart rate multiplied by the
stroke volume, the amount of blood pumped by a
ventricle with each beat. Stroke volume, in turn, depends
on several factors: the rate at which blood returns to the
heart through the veins; how vigorously the heart
contracts; and the pressure of blood in the arteries, which
affects how hard the heart must work to propel blood
into them. Normal cardiac output in an adult is about 3
liters per minute per square meter of body surface.
 An increase in either heart rate or stroke volume—or
both—will increase cardiac output.
 During exercise, sympathetic nerve fibers increase heart
rate.
 At the same time, stroke volume increases, primarily
because venous blood returns to the heart more quickly
and the heart contracts more vigorously
 In a healthy adult during vigorous exercise, cardiac
output can increase six-fold, to 18 liters per minute per
square meter of body surface.
CAUSES

 Myocarditis is an uncommon disorder that is usually

caused by viral, bacterial, or fungal infections that reach
the heart.
VIRAL INFECTIONS:

 Coxsackie
 Cytomegalovirus

 Hepatitis C

 Herpes

 HIV

 Parvovirus
BACTERIAL INFECTIONS:

 Chlamydia
 Mycoplasma

 Streptococcus

 Treponema
FUNGAL INFECTIONS:
 Aspergillus
 Candida
 Coccidioides
 Cryptococcus
 Histoplasma
 Schistosomiasis

 When you have an infection, your immune system produces

special cells that release chemicals to fight off disease. If the
infection affects your heart, the disease-fighting cells enter the
heart. However, the chemicals produced by an immune
response can damage the heart muscle. As a result, the heart
can become thick, swollen, and weak. This leads to symptoms
of heart failure.
OTHER CAUSES OF MYOCARDITIS MAY
INCLUDE:

 Allergic reactions to certain medications or toxins

(alcohol, cocaine, certain chemotherapy drugs, heavy
metals, and catecholamines)
 Being around certain chemicals

 Certain diseases that cause inflammation throughout the

body (rheumatoid arthritis,
sarcoidosis)
 In Central and South America, myocarditis is often due
to Chagas disease, an infectious illness that is
transmitted by insects.
SIGNS AND SYMPTOMS

 Clinical manifestations vary widely but there may be no

manifestations at all.
 The health history may reveal a recent upper respiratory
infections, viral pharyngitis or tonsillitis.
 The most frequent manifestations however are: fatigue,
dyspnea, palpitation and chest pain.
 The client often experiences chest pain as a mild
continuous pressure ore soreness in the chest.
 The chest pain can be distinguish from the effort induce pain
of angina pectoris.
 Tachycardia, if present, may be disproportionate to the
degree of fever, exertion, or illness
 Dysrhythmias can also occur, sometimes producing a
fatal circulatory collapse
 A pericardial friction rub may occur if the client has
pericarditis.
 In adults, they can sometimes mimic those of a heart
attack - mild to severe pain in the center of the chest,
which may radiate to the neck, shoulders, and upper
arms.
 In severe cases, symptoms include breathlessness, rapid
pulse, and heart arrhythmias
 In infants, symptoms may also include bluish skin, heart
murmurs, and a poor appetite.
RISK FACTORS

 Immunodeficientperson
 Who undergone heart transplant

 Heavy Smokers

 Alcoholic

 Obese
COMPLICATIONS

 Possible complication includes:

heart failure
dilated cardiomyopathy and
sudden death from lethal dysrhythmia or
Rupture of myocardialaneurysm
Stroke
Irregular heartbeats (arrhythmias)
LABORATORY
DRUG STUDY

 Penicillins:
Penicillin G Benzathine
 Pregnancy risk: B

 Drug Class
 Antibiotic
 Penicillin Antibiotic
 Actions:

 Bactericidal: Inhibits synthesis of cell wall of

sensitive organisms causing cell death
 Indication:
 Severe infections caused by sensitive organism
(streptococci)
 Prophylaxis of rheumatic fever
 Adverse Effect

 Lethargy, Anemia, Nausea, Vomiting, Abdominal

Pain, Diarrhea, Pain, Phlebitis at injection site
NURSING MANAGEMENT:
 Before:
 Verify doctors order for drug therapy
 Identify patient
 Assess injection site
 During:
 Explain the reason for parenteral routes of
administration
 State action of drug for patient’s education
 After:
 Advice patient to report unwanted effects such as
nausea, vomiting, diarrhea, and pain at injection site.
 Report difficulty of breathing, rashes, severe diarrhea,
severe pain at injection site.
ACE INHIBITOR

 Drug name:
 Enalapril Maleate (Vasotec)
 Drug Class
 ACE inhibitor
 Anti-hypertensive
 Action:

 Decrease BP, blocks the conversion of angiotensin I

to angiotensin II, decreasiong BP, decreasing aldosterone
secretion. In patient with heart failure, peripheral
resistance, afterload, preload, and heart size are decrease.
 Indication:
 Hypertension
 Treatment of Acute and Chronic Heart Failure
 Adverse Effect:
 Heart Attack
 Dizziness
 Chest Pain
 Palpitation
 Nausea and Vomiting
 Polyuria
 Oliguria
 Fainting
 NURSING MANAGEMENT
 Before:
 Verify doctors order about drug therapy
 Monitor patients vital signs especially BP
 Identify patient
 During:
 Explain action of drug for patients education
 Advice to avoid hazardous activities because drugs may cause
dizziness
 Inform patient that excessive perspiration, vomiting, and diarrhea
 After:
 Monitor BP
 Advice patient to change position slowly to minimize orthostatic
hypotension
 Monitor urinary output
 Instruct patient to report untoward effect such as irregular
heartbeat and chest pain
CAPTOPRIL(CAPOTEN)
 Drug class:
 ACE inhibitor
 Anti hypertensive
 Action:

 Block ACE from converting angiotensin I to

angiotensin II, sodium and fluid loss
 Indication

 Hypertension
 Heart Failure
 Diabetic nephropathy
 Left ventricle dysfunction
 Adverse Effect
 Tachycardia
 Hypotension
 Alopecia
 Rash
 Photosensitivity
 Gastric Irritation
 Anorexia
 Constipation
 Fever Chills
 NURSING MANAGEMENT
 Before:
 Verify if patient has allergy to captopril
 Verify doctors order for drug therapy
 Monitor V/S
 Take drug 1hr before meals, do not take with food
 Establish baseline in renal and liver function test before therapy
  
  
 During:
 State action of drug for patients education
 Avoid activities that may be hazardous
  
 After:
 Monitor V/S(BP)
 Advise patient to inform physician/nurse about excessive perspiration,
dehydration, swelling of hands and feet
 Monitor weight daily
QUINIDINE

 Drug Class
 Antiarrhythmic
 Action:
 Decrease automaticity in ventricle, decrease height,
rate of rise of action potential, decrease conducting
velocity, increase fibrillation threshold.
 Indication:

 Atrial arrhythmias, paroxysmal or chronic

ventricular tachycardia
 Adverse Effect:
 Photophobia
 Hypotension
 Nausea and Vomiting
 Diarrhea
 Liver Toxicity
 Dizziness
 Fever
 NURSING MANAGEMENT:
 Before
 Verify doctors order for drug therapy
 Identify the patient
 Have a baseline report of ECG
 Advice patient not to chew on the tablet
 Take drug with food
 Take V/S especially cardiac rate and respiration
  
 During
 State action of drug for patient education
 Do not take grape fruit juice
 Avoid hazardous activity
 After
 Have an ECG result for evaluation for drug effectiveness
 Monitor V/S especially cardiac rate and respiration
 Advise patient to report chest pain, palpitation, and respiratory difficulties
FUROSEMIDE(LASIX)
 Drug Class
 Loop diuretics
 Action:

 Inhibits reabsorption of sodium and chloride from the

proximal and distal tubules and ascending limb of the loop of
henle leading to the sodium rich diuresis
 Indication:
 Heart failure
 Cirrhosis
 Renal Disease
 Acute pulmonary edema
 Hypertension
 Adverse effect
 Dizziness
 Vertigo
 Heart Attack
 Drowsiness
 Fatigue
 Volume depletion
 Rash
 Nausea and Vomiting
 Anorexia
 Constipation
 Polyuria
 NURSING MANAGEMENT
 Before
 Identify if patient has allergy to furosemide
 Verify doctors order for drug therapy
 Identify the patient
 Weight the patient
 Monitor V/S especially BP
 Instruct patient to take medication early in the day to prevent nocturia
 During
 Assist patient in taking the drug or assess injection site
 State the action of the drug for patients education
 After
 Monitor I/O
 Weight the patient
 Assess fluid volume status such as urine color and quality and specific
gravity, skin turgor
 Advise patient to report hearing loss, ear pain, and tinnitus
 Monitor I/O especially BP
SURGICAL MANAGEMENT
NURSING MANAGEMENT

 Assess patient to gather base line data (ongoing

subjective and objective data)
 Monitor vital signs

 Auscultate heart sounds for presence of friction rub

 Assess psychosocial data of client

 Assess base line of nutritional and hydration data

 Force fluid intake

 Encourage to eat nutritious foods

 Administer IV antibiotics as prescribe
 Suggest bed rest

 Supplemental oxygen maybe prescribe

 Administer antipyretic agents as prescribe

 Teach client how to monitor pulse rate and rhythm

 Instruct them to report any sudden change in heart rate,

rhythm or palpitations immediately
 Encourage family members to take CPR training
NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONALE EVALUATION
N
Hyperthermia r/t After 8 hours of > Assess vital > provides
relaease of nursing signs specially indication of core
endrogeneouspyro intervention the axillary temperature.
gen patient will temperature. >as it cools the
maintain normal >cool with tepid skin to rapidly
core body bath, do not use causing shivering
temperature.(37c) alcohol and increase
>monitor BP metabolic rate and
>monitor RR body temperature.
>advise to have >central
adequate fluid hypertension or
intake atleast 2000 peripheral or
cc per day postural
>note presence or hypotension can
absence of occurs.
sweating as body >hyperventilation
attempts to may initially be
increase heat loss present but
by conduction and ventilatory may be
diffusion. impaired by
seizures,
hypometabolicstat
e(shock and
acidosis).
>to prevent
dehydration.
.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONALE EVALUATION
N
> administer > evaporation is
antipyretics as decreased by
ordered refrain environmental
from use of aspirin factors by high
products in humidity ambient
children temperature as
>promotes surface well as body
cooling by means factors producing
of droplight loss of ability to
>provide sweat or sweat
highcalorie diet or glands
parenteral dysfunction.
nutrition. >may cause
Reye’s syndrome
>heat loss by
radiation and
conduction cool
environment and
or fever heat loss
by convection.
>to meat increase
metabolic demand.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Activity The patient will >determine >guides

intolerance r/t utilize energy patients perception treatment.
reduced cardiac conservation of causes of active >to reduce
intolerance.
reserved technique after 8 >encouraged
cardiac woek
hours of nursing adequate rest load.
intervention periods especially >to reduce
before ambulation. energy
>assist with ADL. expenditures
>progress activity >To prevent
gradually such as; over exerting the
1. active ROM
exercise in bed
heart to promote
progressing to attainment of
sitting or standing. short term goals.
2. dangling 10-15 >to promotes
min. TID. awareness of
3. deep breathing when to reduce
exercises TID. activity.
4. walking in room
1-2 min. TID.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIO RATIONALE EVALUATION
N
5. walking on hall >to reduced o2
25 ft., then slowly consumption,
progressing saving allowing more
energy for return prolonged activity
trip. >standing requires
>teach patient or more work.
SO to recognize >distribute work to
signs of physical different muscle to
over activity such avoid fatigue.
as fatigue and >to avoid bending
exhaustion. and reaching.
>teach energy >because is energy
conservation is needed to digest
technique. food.
a. sitting to do >to conserve
task. energy and to
b. changing prevent injury
position from fall.
frequently. >to maintain
c. storing strength/ROM
frequently used endurance game.
items with in easy
reach
d. resting at least 1
hour after meals
before a new
activity.
>teach appropriate
use of
environmental aids
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Excess fluid Will eliminate >administer >to promote

volume r/t fluid excess fluid in the diuretics as fluid diuresis.
retention body after 8 hours ordered. >to prevent
nursing
intervention.
>place in a accumulation of
semi-fowlers fluid
position as >to ensure
appropriate. accurate
>administer IV delivery of iv
fluid via fluids.
infusion pump if >to provide
possible. comparative
>restrict sodium baseline and
and fluid intake evaluate the
as indicated. effectiveness of
>monitor IandO diuretic therapy
and weight >to decrease
> elevated edema
edematous >to reduce
extremities discomfort of
>instruct client fluid restriction.
to frequent oral
care, chewing
gum or hard
candy
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Decrease cardiac After 2-10 shift the >review signs of >early detection of
output r/t altered patient will impending changes promote
heart rhythm demonstrate failure /shock, timely intervention
decrease episodes noting decrease for to limit degree of
of dyspnea and unstable BP/ cardiac
display blood tachypnea, dysfunction.
pressure stability changes in breath .>decreases
sounds and reduce oxygen
urinary output. consumption and
> keep client on risk of
bed or chair rest in decompensation.
position of >to increase
comfort(semi- oxygen available
fowlers position is for cardiac
preferred- legs in function.
20-30 degrees in >to note
shock situation ) effectiveness of
>administer high medication and or
flow oxygen via assistive devices
mask or ventilator .> to allow for
as prescribed. timely alterations
>monitor in therapeutic
cardiacrhythm regimen.
continuously. >to promote
>assess urine adequate rest
output hourly or periods.
periodically, weigh >tomaintain
daily , noting total adequate nutrition
flow balance. and fluid balance
>provide quiet
PATHOPHYSIOLOGY