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Myocarditis and pericarditis treatment

Created by Raja Narayan.

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Video transcript

- So as we know, myocarditis, or inflammation of our myocardium, the muscle that pumps blood out of our heart, and pericarditis, inflammation of the lining right outside of the heart. So myocarditis and pericarditis are most commonly caused, or most commonly are from, some time of virus. So it's most commonly due to some like of viral origin. 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, 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 gonna 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 activity, so don't go and work out if you've got myocarditis or pericarditis 'cause 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. 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 O2 therapy. We can give oxygen from a mask or a nasal canula. And we give O2 to folks for those not delivering enough oxygen to tissue. The next level up of treatments we can provide are 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, are antibiotics. You only, only, only give antibiotics if your myocarditis or pericarditis is from non-viral causes. 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 protozoa. So you don't want to give antibiotics for viral causes. Instead, what you'd give for a viral myocarditis or pericarditis are what are called anti-inflammatory drugs. 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 to more because you have less cells, immune cells, recruited to the sight of inflammation. Less color, 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 mostly 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 immume cells. So they target immune cells and attack them. Our own immume cells. Which isn't good because what if we have a different infection going on and 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. 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 wanna use. Another class of drugs that we can give are what are called, "anti-hypertensive" drugs which you may recognize as blood pressure drugs, things that decrease your blood pressure. So I'll write 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. And so these most commonly are 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 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." which you may recognize as water pills. And this just causes you to pee away excess fluid. So what you're doing instead is that you circulate, 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 that. 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 extracorporeal, now corpus or corporeal just refers to the body, extra means outside of. Extracorporeal membrane, which is where the action's happening. There's an outside the body membrane. Oxygenation, extracorporeal membrane oxygenation. And so that's what we abbreviate as ECMO. This is 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." And 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. And this is definitely very vital to do if you have someone with cardiac tamponade. And finally, the last thing we can do is called a peri, cardiotomy, pericardiotomy. 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, 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. 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.