Other Drugs: The use of immunosuppression therapy is indicated for viral immune-mediated myocardial damage; however, precise drug protocols with corticosteroids, azathio-prine, or cyclosporine are controversial and are generally limited to use with life-threatening complications such as intractable heart failure. Intravenous immunoglobulins may be used such as Gamimune, Gammagard, Gammar-P, Sandoglobulin. These preparations neutralize circulating myelin antibodies and down-regulate pro-inflammatory cytokines.


Focus on maximizing oxygen delivery and minimizing oxygen consumption. Encourage the patient to maintain bedrest with the head of the bed elevated. Stress the importance of bedrest by assisting with bathing, as necessary, and providing a bedside commode to reduce stress on the heart. For patients with enough mobility, encourage active range-of-motion activities to prevent blood stasis. For patients who are acutely ill, extremely weak, or in cardiac failure, perform passive range-of-motion exercises. Provide regular skin care for the patient on bedrest to maintain skin integrity.

In addition to any prescribed analgesics, assist the patient with pain management by teaching relaxation techniques, guided imagery, and distractions. Encourage the patient to sit upright, leaning slightly forward, rather than lying supine. Use pillows to increase the patient's comfort.

Before discharge, be sure to teach the patient about the pathophysiology of myocarditis. Explain the prescribed medications, any potential complications, and lifestyle limitations. Reassure the patient that activity limitations are temporary and that myocarditis is generally a self-limiting condition.

658 Myocarditis

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