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Myocarditis Nursing Guide

The content was created by Bobbi Whittington, RN, BSN

Myocarditis Overview

This course is intended as a Quick Reference for Myocarditis and will cover diagnosing myocarditis, tips for providing care, and nursing considerations for treating patients with Myocarditis.

Etiology and Epidemiology

Myocarditis is the inflammation of the myocardium or heart muscle. The function of the myocardium is to contract and relax to pump blood in and out of the heart allowing blood to flow throughout the body. When the heart muscle becomes infected, it cannot contract and pump normally causing arrhythmias and heart failure.

In 50% of cases, the cause of myocarditis is unknown. Identified causes of myocarditis may include (Al-Akchar & Kiel, 2021):

  • Viral
  • Bacteria
    • Staphylococcus
    • Streptococcus
  • Fungi
  • Parasites
  • Cancer medications
  • Antibiotics
  • Illegal drugs, such as cocaine

The incidence of myocarditis is approximately 1.5 million cases worldwide annually and is estimated between 10 to 20 cases per 100,00 persons (An & Kang, 2021). Myocarditis develops in healthy, young individuals which include children, pregnant women, and those who are immunocompromised.

There are three stages of myocarditis:

  • Acute: Described by direct viral cytotoxicity and focal or diffuse necrosis of the myocardium
  • Subacute: Described by an increase in autoimmune-mediated injury with T cell and B cell activation
  • Chronic: Described by diffuse myocardial fibrosis and cardiac dysfunction

Myocarditis Diagnosis

The diagnosis of myocarditis is made by a thorough history intake and physical examination by the healthcare provider. Clinical presentation of myocarditis for children include:

  • Grunting respirations
  • Intercostal retractions
  • Fever
  • Hypoxia
  • Respiratory distress

Clinical presentation for adults may include:

  • Shortness of breath
  • Chest pain
  • Arrhythmias
  • Fever
  • Tachycardia
  • Edema
  • Rales
  • Fatigue

Individuals normally present with a history of influenza-like symptoms for 7 to 14 days which can include nausea, vomiting, diarrhea, fever, and general malaise.

Diagnostic testing ordered by the healthcare provider may include:

  • Complete blood count
  • Comprehensive metabolic panel
  • C-reactive protein
  • Erythrocyte sedimentation rate
  • Troponin level
  • Viral antibody titers
  • ECG
  • MRI
  • Cardiac catheterization

Management & Treating Myocarditis

In most cases, myocarditis will improve on its own with rest, but some cases require medication or surgery to treat symptoms and the underlying cause of myocarditis, if known. Treatment for this disease includes:

  • Maintain airway, breathing, and circulation
  • Administer oxygen as ordered
  • Administer diuretics as ordered to manage edema
  • Administer antihypertensives as ordered to reduce the strain on the heart
  • Administer antibiotics
  • Ventricular assist device (VAD)
  • Intra-aortic balloon pump
  • Heart transplant
  • Rest
  • Pacemaker placement

Myocarditis Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for myocarditis are listed below.

Assessment

Assess for signs and symptoms of myocarditis, such as:

  • Shortness of breath
  • Chest pain
  • Fatigue
  • Fever
  • Heart arrhythmias
  • Anxiety

Nursing Diagnosis/Risk For

  • Acute pain related to inflammation of the heart muscle, evidenced by:
    • Verbalization of pain
    • Restlessness
  • Activity intolerance related to decreased cardiac output, evidenced by:
    • Inability to complete activities of daily living
      • Fatigue
  • Anxiety related to decreased oxygen supply, evidenced by:
    • Shortness of breath
    • Restlessness

Interventions

  • Monitor pain level
  • Monitor vital signs
  • Provide non-pharmacological interventions for pain
  • Provide a quiet environment
  • Monitor ability to perform activities of daily living
  • Assist with activities of daily living as needed
  • Observe for verbal and non-verbal signs of anxiety
  • Identify ways to decrease anxiety, such as relaxation techniques
  • Encourage participation in activities

Expected Outcomes

  • Verbalizes a decrease in pain
  • Completes activities of daily living without becoming fatigued
  • Demonstrates decreased anxiety
  • Demonstrates effective coping

Individual/Caregiver Education

  • Condition, treatment, and outcomes
  • Review medications and side effects
  • Follow up with healthcare provider or specialist
  • Review importance of reducing the workload on the heart
  • Avoid alcohol and smoking
  • Up-to-date vaccinations
  • Notify healthcare provider or seek medical attention for:
    • Chest pain
    • Fever
    • Shortness of breath
    • Influenza-like symptoms

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Additional Information

Content Release Date

6/11/2024

Content Expiration

12/31/2026

Course Contributor

The content for this course was created by Bobbi Whittington, RN, BSN.

Bobbi started her nursing career as a CNA in long term care and developed a passion for working with older adults in the post-acute setting. She obtained her LPN certificate in 1997 from South Central Area Vocational Technical School in Missouri. Continuing her education, she earned her Associate degree in nursing in 2007 from Texas County Technical Institute in Missouri then obtained her Bachelor of Science degree in nursing from Chamberlain College of Nursing in 2013. Bobbi has over 24 years clinical and managerial experience in the skilled nursing industry.

References

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