Heart Infections: Myocarditis

Myocarditis

• an inflammatory condition of the myocardium that may be caused by
• viral infection
• bacterial infection
• fungal infection
• serum sickness
• rheumatic fever
• chemical agent
• as a complication of collagen disease (Systemic Lupus Erythematosus)

Epidemiology

• may be acute or chronic and may occur at any age
• usually an acute virus and self-limited, but it may lead to acute heart failure

Findings

• depends on the type of infection, degree of myocardial damage, capacity of myocardium to recover, and host resistance
• may be minor or unnoticed - fatigue and dyspnea, palpitations, occasional precordial discomfort manifestations such as mild chest soreness and persistent fever
• recent upper respiration with fever, viral pharyngitis or tonsillitis
• cardiac enlargement
• abnormal heart sounds - murmur, S3 or S4 or friction rub

Levine's Grading of Heart Murmurs

• possibly findings of congestive heart failure such as pulsus alternans, dyspnea and crackles
• tachypnea disproportionate to the degree of the fever

Diagnostic Studies

• ECG (EKG) for changes and arrhythmias
• Labs
• Increases ESR
• Increases myocardial enzymes such as:
• AST
• CK
• LDH
• Endomyocardial biopsy (EMB)
• Myocardial Imaging

Management

• Antibiotics to treat underlying infection
• Corticosteroids to decrease inflammation
• Analgesics for pain
• Oxygen to prevent tissue hypoxia

Nursing Interventions

• The Cardio-Care Six with modified bedrest and less help with Activities of Daily Livings (ADLs)
• Assess for edema, weigh daily; record intake and output

Pitting Edema

• swelling edema in the body most commonly in the extremities caused by excess body fluid
• often affects the lower body such as the legs, ankles and feet
• it is noted upon pressing on a swollen area and an indentation or a PIT remains

• Assess cardiovascular status frequently
• Observe for findings of left-sided heart failure (dyspnea, hypotension or tachycardia)
• Check often for changes in cardiac rythm or conduction by auscultating for heart sounds
• Evaluate arterial blood gas levels as needed to ensure adequate oxygenation

Client and Family Teaching

• Physical activity may slowly be increased to sitting in chair, walking in room, then outdoors
• Avoid pregnancy, alcohol and competitive sports
• Immunize against infections
• Teach client about anti-infective drugs. Stress the importance of taking drugs as ordered by the physician
• Teach clients taking Digitalis:
• Check pulse for one (1) minute before taking the dose and withhold the drug if heart rate falls below 60 beats per minute

• Observe for findings of Digitalis toxicity (anorexia, nausea, vomiting, blurred vision, cardiac arrhythmias) and for factors that may increase toxicity such as electrolyte imbalance and hypoxia
• Teach clients to report rapidly beating heart

Blogsite Owner's Note: PDF copy of this article is available for an affordable fee. Email the site owner at jpherreramd.rn@gmail.com for details.