Myocarditis

WHAT YOU SHOULD KNOW:

• Myocarditis (mi-o-kar-DI-tis) is an inflammation (swelling) of the myocardium (heart muscle). The myocardium pumps blood in and out of the heart and to other parts of the body. With myocarditis, the heart muscles are damaged and scars may form in them. This makes the heart weak and work harder to supply oxygen to the rest of your body. Over time, the increased pressure to pump blood may cause the heart to enlarge and become overworked. This may lead to heart failure and a decreased blood flow to the organs. Blood clots may develop and cause other life-threatening conditions, such as a stroke or heart attack. The most common cause of myocarditis is an infection caused by germs, especially viruses.
  
  
• Myocarditis may occur as an acute (sudden) or chronic (long term) heart problem. At the start of your disease, you may have fever, cough, or diarrhea (loose bowel movement). As your heart weakens and fails to pump, you may have chest pain or trouble breathing. Other symptoms include fatigue (tiredness), dizziness, fainting (passing out), or having too fast or irregular heartbeats. Myocarditis is diagnosed by blood tests, chest x-ray, biopsy, magnetic resonance imaging (MRI) scan, electrocardiogram (ECG), and echocardiography. Caregivers may suggest that you rest and limit physical activities so your heart will not work too hard.
  
  
• Treatment may include oxygen, medicines, such as antivirals or diuretics, cardiac devices, or implants, and surgery. With proper treatment, you have a greater chance of recovery and preventing further problems. Ask your caregiver for more information about these tests and treatments.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• Myocarditis is a serious, life-threatening condition, and treatment should begin as soon as possible. Your health, quality of life and ability to function may change. Treatment for myocarditis may cause unwanted side effects. Surgery and devices for myocarditis may increase the chances of getting a heart infection or bleeding. Medicines may cause you to have rashes, nausea (upset stomach), vomiting, or stomach ulcers (sores).
  
  
• If not treated early, your heart may continue to weaken and totally fail. This may cause decreased blood flow to the organs and other parts of the body. The blood may also flow back up into the lungs and cause more problems. Your lungs may become filled with fluid and cause severe shortness of breath or respiratory failure. Sometimes, those who have myocarditis may suddenly collapse (pass out) and die. Even if you have treatment, there is still the chance that your heart will fail. Ask your caregiver if you have questions or concerns about your condition, medicines, or care.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Activity: At first you may need to rest in bed. It may be easier for you to breathe if you rest with the head of your bed raised. You can also breathe easier if you rest your head on three or four pillows. Resting in a reclining chair may also help you breathe better. Another way to breathe easier is by saving your energy and resting more. If you have trouble breathing, call your caregiver right away. You may get out of bed when your breathing has improved.

Diet:

• Eat a variety of healthy foods every day. Your diet should include fruits, vegetables, breads, dairy products, and protein (such as chicken, fish, and beans). Eating healthy foods may help you feel better and have more energy.
  
  
• Ask your caregiver if you should be on a special diet. You may be told to eat foods that are low in fat or cholesterol. You may also be told to limit the amount of salt you eat. Special cookbooks can make it easier to plan low fat and low salt meals.
  
  
• Weighing too much can make your heart work harder and can cause serious health problems. Talk to your caregiver about a weight loss plan if you are overweight.

Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.

IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Medicines: You may need any of the following:

• Antibiotics or antivirals: Antibiotics or antiviral medicines may be given to help treat or prevent an infection caused by bacteria or viruses.
  
  
• Blood pressure medicine: This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
  
  
• Clot busters: This medicine helps break apart blood clots, which may increase blood flow to your heart muscle. It is given in your IV and may be given at the same time as other blood thinners. This medicine may decrease the amount of damage to your heart muscle, and may even save your life. You will bleed and bruise more easily after getting clot busters.
  
  
• Diuretics: This medicine is often called "water pills". Diuretics help your body get rid of extra fluid (edema) in your legs and ankles. This medicine may also help get rid of extra fluid in your lungs or around your heart. It may also decrease your blood pressure. You may urinate more often when taking diuretics.
  
  
• Heart medicine: This medicine may be given to make your heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Tell caregivers right away if you start feeling discomfort, pressure, burning, or tightness in your chest. Tell caregivers right away if you start sweating, have trouble breathing, or feel discomfort in your arm, back, neck, or jaw. Any of these may be a sign that your heart is not getting enough oxygen, and may need medicine to help.
  
  
• Others: In some cases, an immune globulin or immunosuppressant may be offered to help treat myocarditis. Ask your caregiver for more information about how these medicines may help you.
  
  
  • Immune globulin: Immune globulin may help your immune system fight infection. This medicine may help if your system fights something in your blood or body that it should not.
    
    
  • Immunosuppressant: This medicine prevents the immune system from attacking your body. This may be offered if you have certain immune diseases.

Pulmonary artery line: A pulmonary artery line, or PA cath, is a kind of central line catheter. It is a thin tube put in a vein near your collarbone, or in your neck or groin. The tube is then guided through your heart and into a blood vessel that goes to your lungs. One end of this catheter is hooked to a machine called a monitor. The monitor shows numbers that tell caregivers how your heart and lungs are doing. The part of this catheter that is inside you may be used to give you medicine. You will need a chest x-ray after the PA line is placed, to be sure the line is where your caregiver wants it. You may have stitches on your skin where the line comes out. This holds the line in place.

Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.

Tests: You may have any of the following:

• Biopsy: Caregivers may need to remove a small part of your heart muscle. The muscle tissue will then be sent to the lab for tests.
  
  
• Blood gases: This test is also called an arterial blood gas or ABG test. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. The groin is the area where your abdomen meets your upper leg. Your blood is tested for the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  
  
• Imaging tests:
  
  
  • Cardiac catheterization: This is a test to see how well your heart is working. Your arteries (blood vessels) may also be checked to see if they are blocked. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen.
    
    
  • Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
    
    
  • Echocardiogram:
    
    
    • This test is also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen.
      
      
    • This test is done while lying down on your back. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor will be rubbed across your chest to see your heart from different angles. You may hear a whooshing noise, which is the sound of your blood flow. Caregivers may ask you to pedal a bike during the test (exercise echo) or you may get medicine before the test to increase blood flow to your heart muscle (stress echo). This test can tell how well your heart is pumping. An echo can also find problems, such as fluid around the heart or problems with your heart valves.
    
    
  • Magnetic resonance imaging scan: This test is also called an MRI. An MRI uses magnetic waves to take pictures of your chest. During an MRI, pictures are taken of your heart, lungs, muscles, and blood vessels. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.
    
    
  • Nuclear scan: This test uses a small, safe amount of radioactive chemical. After injecting the chemical into your vein, pictures of your heart and its blood vessels are taken. The pictures will tell caregivers how well your heart is working. It can also show how much blood is pumped out of the heart with each contraction (heartbeat).
    
    
  • Pulmonary angiogram: A pulmonary angiogram is done to check for problems with blood flow in your heart and lungs. A catheter (long, thin, bendable tube) is placed in a vein in your neck, under your collarbone, or in your groin. The groin is the area where your abdomen meets your upper leg. The catheter is then pushed into the pulmonary artery. Dye is put into the catheter. Chest x-rays are taken after the dye goes to your heart and lungs. The dye helps the blood vessels show up better on these x-ray pictures. Tell your caregiver if you are allergic to shellfish, as you may also be allergic to the dye used for this test.

Treatment options:

• Heart device: This device placed in your chest may do all or part of the pumping for your heart. This may also help monitor and control your heart rate and rhythm. It may slow your heartbeat down, speed it up, or make it more regular.
  
  
• Respiratory support: You may need extra oxygen or a ventilator to help you breathe easier.
  
  
  • Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
    
    
  • Ventilator: A ventilator is a special machine that can breathe for you if you cannot breathe well on your own. You may have an endotracheal tube (ET tube) in your mouth or nose. A tube called a trach may go into an incision (cut) in the front of your neck. The ET tube or trach is hooked to the ventilator. The ventilator can also give oxygen to you.
  
  
• Surgery: Caregivers may do different surgeries to fix your heart. A part of the enlarged heart muscle may be removed. The heart valves may also be repaired or replaced. Sometimes, a heart transplant may be needed if your heart is failing. The diseased heart is removed and replaced with a healthy and donated heart.

Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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