Viral Myocarditis.

In recent years, more young patients are being admitted to hospitals with the diagnosis of heart failure secondary to myocarditis; many of these patients will progress to needing a heart transplant. Research shows that heart failure is increasing in prevalence and incidence and is expected to have 46% increases in prevalence by 2030, with hypertension, diabetes, and obesity pointed as risk factors (Cardiac Fail Rev. 2017;3(1):7-11). Nurses need to be aware of and educated on the infectious processes responsible for heart failure, presumable pathogens, new and emerging diagnostic tests, and possible treatments. This article explores the viral pathogens commonly found to cause myocardial inflammation, their sequelae, and treatment.

Cardiac infections: medical and surgical therapies.

Infections of the heart can be acute or subacute, depending on host susceptibility, the cause and associated virulence, early diagnosis, and effective therapy. The following review will discuss the causes, clinical manifestations, diagnosis, and medical or surgical management of infective endocarditis, prosthetic valve endocarditis, myocarditis, and pericarditis. Nursing considerations emphasize understanding the pathogenesis, early recognition of signs and symptoms, and appropriate prevention and intervention.

Viral myocarditis in children.

Viral myocarditis is the result of a viral infection that produces myocardial necrosis and triggers an immune response to eliminate the viral agent. Many pathogenic mechanisms may contribute to myocardial cell loss including the following: cytokine production contributing to disease severity; viral persistence, which may produce an autoimmune response to cardiac myosin; and viral invasion of vascular endothelium causing vascular spasm with reperfusion injury. The compensatory response of the myocardium to these mechanisms of cell loss is hypertrophy, which results in fibrosis, scarring, and dilation. The myocardial cell loss and physiological response produces a child with fever, lethargy, symptoms of congestive heart failure, cardiogenic shock, or new onset arrhythmias. The initial presentation may be subtle, but if left untreated will go on to produce severe symptoms. The focus of diagnostic studies is to evaluate cardiac function, identify the viral agent, and eliminate other causes of global cardiac dysfunction. Treatment must provide for support of cardiac function through inotropic and afterload-producing agents while providing rest for the stressed cardiac muscle. The nursing care of children with viral myocarditis must focus on continual assessment of the cardiovascular system while supporting the recovery of myocardial function.

Miocarditis viral asociada a bronquiolitis por virus sincitial respiratorio

La bronquiolitis por virus sincitial respiratorio (USR) es una enfermedad de las vías aéreas pequeñas, caracterizada por inflamación y obstrucción de los bronquiolos. El VSR fue aislado por primera vez en 1995, pertenece a la familia de los paramixovirus. Es clara la presentación epidérmica anual que compromete especialmente a lactantes pequeños. La tasa de infección por VSR durante el primer año de vida alcanza el 69 por ciento y el 83 por ciento durante el segundo. La mortalidad en niños previamente sanos es del 0.005 por ciento al 0.002 por ciento; en pacientes hospitalizados es del 1 al 3 por ciento. Aunque se ha descrito que la infección por VSR no altera la función cardíaca en pacientes con corazón sano, se encuentra en la literatura informes aislados al respecto; a continuación presentamos un caso de un paciente con bronquiolitis por VSR, en el que se documentó miocarditis por este mismo germen.

Myocarditis: review of a clinical enigma.

Myocarditis is a disease process that is poorly understood. The incidence of myocarditis may vary with age, sex, and season of the year. The pathogenesis of myocarditis has been studied in animal models. Several investigators have documented the development of myocardial damage in mice after infection with a virus. Patients with myocarditis may present with highly variable clinical pictures ranging from no clinical manifestations to overt clinical congestive heart failure or sudden death. Endomyocardial biopsy is necessary to confirm the diagnosis of myocarditis. There are conflicting data regarding treatment of myocarditis. Immunosuppression may be useful in reducing myocardial inflammation and preventing irreversible myocardial damage. Nurses participate in care of patients during evaluation and treatment for myocarditis. Ongoing assessment of cardiac function is imperative at all times.