Treatments for Autoimmune Myocarditis
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Chest Pain:
Treatment
(In a Page: Signs and Symptoms)
-
Attention to airway, breathing, and circulation
-
All patients with suspected coronary artery disease should initially be treated with supplemental O2, aspirin, and nitroglycerin; morphine may be added if pain does not subside
-
- If an acute myocardial infarction is suspected, β-blockers, ACE inhibitors, heparin (usually low molecular weight heparin, enoxaparin), thrombolytic therapy or primary angioplasty (PTCA), and/or glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide, abciximab, or tirofiban) may be indicated
Treat other etiologies as appropriate (e.g., antiarrhythmics and/or cardioversion for arrhythmias, pericardiocentesis for cardiac tamponade, H2 blockers or PPIs for GERD and peptic ulcer disease, antibiotics for pneumonia, bronchodilators and steroids for asthma)
Emergent surgery for aortic dissections that involve the aortic arch proximal to left subclavian artery (type A); strict blood pressure control for type B dissections that only involve the aorta distal to left subclavian artery
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Chest Pain:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Most patients/families with chest pain simply want reassurance that symptoms are not cardiac in origin
-
A careful history and physical exam are most important; however, a normal CXR and ECG provide therapeutic reassurance to the patient/family
-
Further cardiology consultation is rarely required but should be considered with patients experiencing chest pain with exercise, a history of Kawasaki disease, Marfan syndrome (this is an emergency), and for those patients with persistent chest pain
-
Costochondritis: Treated with NSAIDs until resolved
-
Pericarditis: Treated with aspirin or NSAIDs; requires cardiology follow-up until resolved, rarely requires pericardiocentesis
-
Appropriate therapy of identified pulmonary, gastrointestinal, or musculoskeletal problems
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Chest pain:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient when his chest pain began. Did it develop suddenly or gradually? Is it more severe or frequent now than when it first started? Does anything relieve the pain? Does anything aggravate the pain? Ask the patient about associated symptoms. Sudden, severe chest pain requires prompt evaluation and treatment because it may herald a life-threatening disorder. (See Managing severe chest pain, pages 134 and 135.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Endocarditis:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Antimicrobials, supportive care (nutritional therapy, antipyretics, sufficient fluid intake)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Myocarditis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment includes antibiotics for bacterial infection, modified bed rest to decrease heart workload, and careful management of complications. Inotropic support of cardiac function with amrinone, dopamine, or dobutamine may be needed. Heart failure requires restriction of activity to minimize myocardial oxygen consumption, supplemental oxygen therapy, sodium restriction, diuretics to decrease fluid retention, and cardiac glycosides to increase myocardial contractility. However, cardiac glycosides should be administered cautiously because some patients with myocarditis may show a paradoxical sensitivity to even small doses. Arrhythmias necessitate prompt but cautious administration of antiarrhythmics because these drugs depress myocardial contractility. Thromboembolism requires anticoagulation therapy. Treatment with corticosteroids or other immunosuppressants may be used to reduce inflammation, but they haven’t been shown to change the progression of myocarditis infections. Nonsteroidal anti-inflammatory drugs are contraindicated during the acute phase (first 2 weeks) because they increase myocardial damage.
Surgical treatment may include left ventricular assistive devices and extra corporeal membrane oxygenation for support of cardiogenic shock. Cardiac transplantation has been beneficial for giant cell myocarditis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Pericarditis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The goal of treatment is to relieve symptoms and manage the underlying systemic disease. In acute idiopathic pericarditis and postthoracotomy pericarditis, treatment consists of bed rest as long as fever and pain persist, and nonsteroidal drugs, such as aspirin and indomethacin, to relieve pain and reduce inflammation. Post-MI patients should avoid nonsteroidal anti-inflammatory drugs and steroids because they may interfere with myocardial scar formation. If these drugs fail to relieve symptoms, corticosteroids may be used. Although corticosteroids produce rapid and effective relief, they must be used cautiously because episodes may recur when therapy is discontinued.
Infectious pericarditis that results from disease of the left pleural space, mediastinal abscesses, or septicemia requires antibiotics (possibly by direct pericardial injection), surgical drainage, or both. Cardiac tamponade may require pericardiocentesis. Signs of tamponade include pulsus paradoxus, jugular vein distention, dyspnea, and shock.
Recurrent pericarditis may necessitate partial pericardectomy, which creates a “window’’ that allows fluid to drain into the pleural space. In constrictive pericarditis, total pericardectomy to permit adequate filling and contraction of the heart may be necessary. Treatment must also include management of rheumatic fever, uremia, tuberculosis, and other underlying disorders.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Chest pain:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient when his chest pain began. Did it develop suddenly or gradually? Is it more severe or frequent now than when it first started? Does anything relieve the pain? Does anything aggravate it? Ask the patient about associated symptoms. Sudden, severe chest pain requires prompt evaluation and treatment because it may herald a life-threatening disorder. (See Managing severe chest pain, pages 162 and 163.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Endocarditis:
Treatment
(Handbook of Diseases)
The goal of treatment is to eradicate the infecting organism. Antimicrobial therapy should start promptly and continue over 4 to 6 weeks. Selection of an antibiotic is based on identification of the infecting organism and on sensitivity studies. While awaiting test results or if blood cultures are negative, empiric antimicrobial therapy is based on the likely infecting organism.
Supportive treatment includes bed rest, aspirin for fever and aches, and sufficient fluid intake. Severe valvular damage, especially aortic or mitral insufficiency, may necessitate corrective surgery if refractory heart failure develops or in cases in which an infected prosthetic valve must be replaced.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Myocarditis:
Treatment
(Handbook of Diseases)
Treatment includes an antibiotic for bacterial infection, modified bed rest to decrease the cardiac workload, and careful management of complications. Heart failure requires restriction of activity to minimize myocardial oxygen consumption, supplemental oxygen therapy, sodium restriction, a diuretic to decrease fluid retention, and a cardiac glycoside to increase myocardial contractility. However, cardiac glycosides must be administered cautiously because some patients with myocarditis show a paradoxical sensitivity to even small doses.
Arrhythmias necessitate prompt but cautious administration of antiarrhythmics, which can depress myocardial contractility. Thromboembolism requires anticoagulation therapy. Treatment with a corticosteroid or other immunosuppressant is controversial and therefore limited to combating life-threatening complications such as intractable heart failure.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Pericarditis:
Treatment
(Handbook of Diseases)
The goal of treatment is to relieve symptoms and manage underlying systemic disease.
Bed rest and drug therapy
With acute idiopathic pericarditis, post-MI pericarditis, and postthoracotomy pericarditis, treatment consists of bed rest while fever and pain persist and nonsteroidal anti-inflammatory drugs, such as aspirin and indomethacin, to relieve pain and reduce inflammation.
If these drugs fail to relieve symptoms, corticosteroids may be used. Although corticosteroids produce rapid and effective relief, they must be used cautiously because episodes may recur when therapy is discontinued.
Infectious pericarditis that results from disease of the left pleural space, mediastinal abscesses, or septicemia requires antibiotics (possibly by direct pericardial injection), surgical drainage, or both. Cardiac tamponade may require pericardiocentesis. Signs of tamponade include paradoxical pulse, jugular vein distention, dyspnea, and shock.
Pericardectomy
Recurrent pericarditis may necessitate a partial pericardectomy, which creates a “window” that allows fluid to drain into the pleural space. In constrictive pericarditis, a total pericardectomy to permit adequate filling and contraction of the heart may be necessary. Treatment must also include management of rheumatic fever, uremia, tuberculosis, and other underlying disorders.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Chronic fatigue and immune dysfunction syndrome:
Treatment
(Handbook of Diseases)
Treatment is aimed at the cause, if one can be found. Supportive therapy includes an anti-inflammatory, an antihistamine, and rest.
Treatment of symptoms may include a tricyclic antidepressant (doxepin), a histamine2-blocker (cimetidine), and an anxiolytic (alprazolam). In some patients, avoidance of environmental irritants and certain foods may help to relieve symptoms.
Experimental treatments include the antiviral acyclovir and selected immunomodulators, such as I.V. gamma globulin, ampligen, and transfer factor.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Chest pain:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
As needed, prepare the patient for cardiopulmonary studies, such as an ECG and a lung scan. Perform a venipuncture to collect a serum sample for cardiac enzyme and other studies. Assess the cardiovascular system frequently. Interpret changes in cardiac rhythm. Be prepared for emergency procedures.
Keep in mind that a patient with chest pain may deny his discomfort, so stress the importance of reporting symptoms to allow adjustment of his treatment.
Patient teaching
Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety. Prepare him if cardiac catheterization or fibrinolytic therapy is indicated. Explain the purpose of any prescribed drugs and make sure that he understands the dosage, schedule, and possible adverse effects. Teach the patient with coronary artery disease to recognize the typical features of cardiac ischemia as well as symptoms that require prompt medical attention. Teach him how to administer sublingual nitroglycerin and advise him to seek medical attention if the pain lasts more than 20 minutes, fails to respond to nitroglycerin, or has a different pattern than the usual angina.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Chest pain:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Teach patients with coronary artery disease about the typical features of cardiac ischemia as well as the symptoms that should prompt them to seek medical attention. If the pain fails to disappear after sublingual nitroglycerin, lasts more than 20 minutes, or has a different pattern from the usual angina, the patient must be evaluated immediately.
Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety. Also explain the purpose of any prescribed drugs, and make sure that the patient understands the dosage, schedule, and possible adverse effects.
Keep in mind that a patient with chest pain may deny his discomfort, so stress the importance of reporting symptoms to allow adjustment of his treatment.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Chest pain:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for cardiopulmonary studies, such as an electrocardiogram, chest X-ray, magnetic resonance imaging, and a lung perfusion scan.
▪ Collect a serum sample for cardiac enzyme and electrolyte levels.
▪ Provide emotional support because chest pain produces increased anxiety.
Patient teaching
▪ Explain the purpose and procedure of each diagnostic test to the patient to help alleviate his anxiety.
▪ Teach the patient about the cause of his chest pain once a diagnosis is established.
▪ Explain the purpose of any prescribed drugs, and make sure that the patient understands the dosage, schedule, and possible adverse effects.
▪ Stress the importance of reporting symptoms to allow for the adjustment of treatment.
▪ Teach the patient with coronary artery disease about the typical features of cardiac ischemia as well as the symptoms that should prompt him to seek immediate medical attention.
▪ Discuss lifestyle changes that can reduce the risk of coronary artery disease.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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