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Current time:0:00Total duration:10:38

Video transcript

so as we know myocarditis myocarditis or inflammation of our myocardium the muscle that pumps blood out of our heart and pericarditis pericarditis inflammation of the lining right outside of the heart so myocarditis and pericarditis are most commonly caused or most commonly are from some type of virus so it's most commonly due to some type of viral origin okay and for most cases viruses can be defeated by the immune system and so we say that most commonly myocarditis and pericarditis are what's called self-limited self-limited diseases self-limited which basically means that given enough time the immune system the immune system will eventually prevail so there are a couple of things that we can do to treat myocarditis and pericarditis the first thing we can do is provide what's called supportive care and I'm going to go from least invasive to most invasive treatments that we can provide supportive care is just doing anything but giving medications or doing any procedures so this can be something like advising a patient to limit physical activities so don't go and work out if you've got myocarditis or pericarditis because it'll cause unnecessary strain on your heart so limit your physical activity you can also recommend that they sleep with an elevated head of bed so elevated head of bed and this achieves the same thing because we have less blood coming to the heart when we have the heart above the legs so there's less pressure on the heart when you're laying with your head above the legs as opposed to laying flat the other thing we can do is just standard to therapy we can give oxygen from a mask or a nasal cannula and we give you two folks for those not delivering enough oxygen so not delivering enough oxygen to tissue the next level up of treatments we can provide our certain medications so we can give certain meds to help with their myocarditis or pericarditis the first one I'll mention right off the top just so we can deal with this concept first our antibiotics you only only only give antibiotics if your myocarditis or pericarditis is from from non viral causes non viral you never give antibiotics for viral myocarditis or viral pericarditis there's no point to do it and instead you're increasing resistance or making it so that the antibiotic will not work in the future against certain bacteria or certain fungi or certain persona so you don't want to give antibiotics for viral causes instead which you'd give for a viral myocarditis or pericarditis are what are called anti-inflammatory drugs so anti-inflammatory and there are several classes of anti-inflammatory drugs the most commonly or the first-line ones that we use are called non-steroidal anti-inflammatory drugs non-steroidal anti-inflammatory drugs and these are just your standard things like Advil or motrin and these make it so that the chemicals released from immune cells that cause inflammation are limited in action so you have less - more because you have less cells immune cells recruited to the site of inflammation less calor or less fever because you block some of the chemicals that are released that are supposed to cause the fever if NSAIDs or non-steroidal anti-inflammatory drugs are not enough you can add what's called colchicine colchicine is also an anti-inflammatory drug and it's usually used in gout so it's used in gout most commonly but it definitely works here to limit inflammation and if these two don't work together then you have to go to steroids and steroids are really heavy-duty drugs that you may know about that work instead of impairing the chemicals they actually impair immune cells so they target immune cells and attack them our own immune cells which isn't good because what if we have in a different infection going on then our immune cells can't attack that other infection because steroids are limiting them from causing inflammation for our myocardium as well as inflammation where it should be going on and the other thing on top of that steroids cause many side effects many side effects and you can't stop using them abruptly because you'll have certain impairments to your adrenal glands which are glands that are responsible for your blood pressure regulation and a bunch of other things so steroids are definitely the last line of anti-inflammatory drugs you'd want to use another class of drugs that we can give are what are called anti hypertensive drugs antihypertensive drugs which you may recognize as blood pressure drugs things that decrease your blood pressure so I'll right here decrease your blood pressure and there are many mechanisms that we can decrease the blood pressure by there are drugs that act directly on the heart so act on heart and so these most commonly are beta blockers beta blockers like if you've heard of metoprolol that's a beta blocker there are anti hypertensive drugs that act away from heart or act elsewhere in the body these include things like angiotensin converting enzyme inhibitors so angiotensin converting and inhibitors so ACE inhibitors and they also include angiotensin ii receptor blockers or ARBs and a subset of that that I'll mention separately are drugs that are called diuretics dye your etics which you may recognize as water pills and this just causes you to pee away POA excess fluid excess fluid so what you're doing instead is that you circulate circulate concentrated blood concentrated blood and now if these medications don't work there are certain procedures that we can do or surgeries if you can call it add procedures or surgeries that can help alleviate some of the symptoms or perhaps some of the causes of myocarditis or pericarditis one of the things we can do to oxygenate our blood if our myocardium is impaired or the pericardium is too constrictive is to give a patient or put them on ECMO which is short for extra corporeal corp or real now corpus or corporal just refers to body extra means outside of extracorporeal membrane membrane which is where the action is happening there's an outside the body membrane oxygenation extracorporeal membrane oxygenation and so that's what we abbreviate as ECMO ECMO this is a machine so let's say a machine that acts like the heart and the lungs so it acts like the lungs because we oxygenate tissue or sorry we oxygenate our blood and then it also acts like the heart because it pumps blood back to our circulatory system another procedure we can do that I touched on briefly is called a pericardiocentesis a pericardiocentesis this is used to alleviate a pericardial effusion if there's a lot of fluid in the pericardial space what we'll do is we'll use a needle to drain the pericardial space so the needle will drain the pericardial space and this is definitely very vital to do if you have someone with cardiac tamponade and finally the last thing we can do is what's called a peri cardi pericardial t'me which is to remove a part of the pericardium it's also referred to and you may have heard of this term a pericardial window so you're making a pericardial window because what you do is you make a permanent channel permanent channel between your pericardial space so the pericardial space that may be filling up with an effusion or causing cardiac tamponade so the pericardial space and the chest cavity chest cavity and this is done when you have recurrent pericardial effusions that can't be explained if we make a pericardial window that makes it so that our patient won't recurrently have these symptoms because now there's a place for the fluid or the blood or whatever it is to drain away from the space around the heart so we don't compress on the heart but again this is a very advanced procedure that we would do only if you really need to make this channel because it's a very invasive thing to do to go in and just cut away a part of the pericardium it's taking away a part of the heart