 Hi, welcome to nursing school explained in this video on myocarditis. As a refresher, the heart actually has three layers. The innermost layer that also includes the heart valves is the endocardium. The myocardium is actually the meaty part of the muscle, the actual muscle part that contracts. And then the pericardium is the layer around the heart. In myocarditis, it's basically inflammation of the cardiac muscle is what this means. And causes can be anything infectious such as viruses, bacteria and fungi, as well as radiation treatment. So patients that undergo radiation treatment for any kind of maybe breast cancer, lung cancer, anything like that. And autoimmune diseases can also lead to myocarditis. Signs and symptoms can be pretty big initially where the patient might have a fever, some fatigue, a theralgia, meaning joint pain, as well as shortness of breath and enlarged lymph nodes. They might also have nausea and vomiting. So basically overall just infectious type symptoms such as you would expect even with the flu or some similar upper respiratory infection. But after about 7 to 10 days, the patient starts to develop pleuridic chest pain. And then they can also develop what's called a pericardial friction rub. Now going back here to the drawing, when the myocardium, that muscle gets inflamed, it will basically enlarge in size. And then the space in that myocardial space where that fluid is that provides the lubrication gets a little bit more narrow. Which means that the surface is now rub against each other and that we can pick that up with a stethoscope and it's called a pericardial friction rub. Now the inflammation of the myocardium can also lead to a pericardial effusion. Which basically means that now we're also accumulating leukocytes and all kinds of other inflammatory cells that now come to the aid of fighting this inflammation of the heart muscle, meaning that there's now more fluid in that pericardial sac, which can then put pressure on the myocardium. If there's more fluid around the heart, it will be it will prevent it from pumping and expanding. So that can lead to pericardial effusion, which can be dangerous. And it can also lead to pericarditis. So now that pericardial effusion, I'm sorry, the pericardial fluid in that pericardial cavity can become inflamed as well. And then all these signs and symptoms together might lead to heart failure symptoms. And the patient might have tipper as a typical JVD. You might hear an S3 that might be crackles in the lungs. They will probably have peripheral edema. And they might have signs and symptoms of angina, such as chest pain, diaphoresis, dizziness, nausea, any of those. Now diagnostic tests for anything that involves the heart is always going to involve an EKG to check for dysrhythmias, as well as CBC might show an elevated white count depending on the underlying cause of it. There's also going to be elevations in ESR and CRP, which are always non-specific inflammatory markers that tell us that there's something going on in the body in terms of inflammation. Troponin might be elevated because it affects the heart muscle and its ability, and it might lead to damage there of the coronary arteries. Viral titers might be indicated if we're suspecting the cause of it is a virus of some sort, echocardiogram to look at the heart valves and the overall functioning, injection fraction of the heart, as well as the chest x-ray for basic structure of the heart and lungs. The patient might also need an MRI for more detailed imaging of the heart, and then they might need an endomyocardial biopsy, which basically just means that the heart muscle itself and the inner layer of the endocardium are biopsied so that we can detect what is going on there, what is the causative organism of the inflammation of that myocardium. Now, the most common complication from myocarditis is dilated cardiomyopathy, which basically means whatever agent is causing the invasion of the myocytes, so virus, bacteria, or fungi, causes cell damage that can then become necrotic. When the heart muscle becomes necrotic, it's not going to be able to function and that cardiac muscle is going to be diseased, resulting in dilated cardiomyopathy. Now, in terms of management, we basically want to manage the signs and symptoms of heart failure that we discussed over here. So that will include ACE inhibitors, beta blockers, diuretics, most commonly Lasix, digoxin, which is a positive inotrope, which will help with the contractility of the heart, and then anticoagulants because in heart failure, as you know, patients are at higher risk for clotting and when the blood is a little bit thinner, it'll allow the heart to pump the blood to the body and perfuse the tissues more easily. If the underlying causes an autoimmune disorder, the patient will go on auto... I'm sorry, on immunosuppression therapy. But as discussed, if the complication of dilated cardiomyopathy occurs, all this management of heart failure might only get us so far and the patient actually may require a heart transplant. Now, nursing care in myocarditis basically involves managing the heart failure, so we want to make sure that the heart's contractility is improved through the administration of the dioxin and then also reducing the pre and after load by administering the ACE inhibitors as well as the diuretics and anticoagulants, really. We want to elevate the head of the bed because most of the time the patient will have signs and symptoms of heart failure, shortness of breath and fluid volume overload, so that will help them. Because the heart muscle is diseased, they're going to be very fatigued easily, so we want to alternate rest with activity, decrease environmental stimuli and then do whatever we can to decrease their anxiety. Thanks for watching this video on myocarditis. Please also refer to the other videos about the inflammatory heart disorders that involve the endocardium and pericardium. Thanks for watching Nursing School Explained.