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. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. 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:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Rest:

Keep the head of your bed raised to help you breathe easier. You can also raise your head and shoulders up on pillows or rest in a reclining chair. If you feel short of breath, let caregivers know right away.

Good nutrition for your heart:

Get enough calories, protein, vitamins, and minerals to help prevent poor nutrition and muscle wasting. You may be told to eat foods low in cholesterol or sodium (salt). You also may be told to limit saturated and trans fats. Do eat foods that contain healthy fats, such as walnuts, salmon, and canola and soybean oils. Eat foods that help protect the heart, including plenty of fruits and vegetables, nuts, and sources of fiber. Ask what a healthy weight is for you. Set goals to reach and stay at that weight.

Intake and output:

Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

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 is given to lower your blood pressure. A controlled blood pressure helps protect your organs, such as your heart, lungs, brain, and kidneys. Take your blood pressure medicine exactly as directed.
  
  
• 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 given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.
  
  
• Heart medicine: This medicine is given to strengthen or regulate your heartbeat. It also may help your heart in other ways. Talk with your caregiver to find out what your heart 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 device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

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 is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• 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 a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
    
    
  • 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 if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
    
    
  • Ventilator: This is a machine that gives you oxygen and breathes for you when you cannot breathe well on your own. An endotracheal (ET) tube is put into your airway through your mouth or nose. You may need a trach if an ET tube cannot be placed. A trach is an airway tube put into an incision (cut) in the front of your neck. The ET tube or trach is attached to the ventilator.
  
  
• 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:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

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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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