Cardiomyopathy

Prepared

By

Dr. Hanan Said Ali

Objectives

Define cardiomyopathy. Classify of cardiomyopathy.Enumerate etiology of cardiomyopathy.Enumerate clinical manifestation.Identify diagnostic studies of the disease.State the complications.Describe how to manage cardiomyopathy.

Cardiomyopathy

Definition

is a heart muscle disease associated with cardiac dysfunction.

Cardiomyopathy may lead to severe heart failure, dysrhythmias.

CardiomyopathyClassification of cardiomyopathy

PrimaryThere is primary structural and functional disability of the myocardium

The heart muscle is the only structure affected and other cardiac structure are not affected.

SecondaryIs usually precipitated by a cause, such as ischemia, viral infection, alcohol intake, drug abuse or pregnancy

Cardiomyopathy

Classification according to anatomic and Pathophysiologic process

1. Hypertrophic CardiomyopathyIt is recognized by inappropriate left ventricular hypertrophy, decreased cardiac output and outflow obstruction.

2. Restrictive CardiomyopathyIt is characterized by myocardial muscle mass. There is impairment of diastolic filling of the heart. It due to ventricular thrombosis

Cardiomyopathy

Classification according to anatomic and Pathophysiologic process Cont.

3. Dilated cardiomyopathy

It is characterized by dilatation of the ventricles with subsequent impairment of systolic function.

Cardiomyopathy

Etiology

Ineffective calcium binding by the myocardium results in decreased left ventricular contractility caused by:-

An autoimmune process related to a viral disease .

A focal transient spasm of small blood vessels.

Cardiomyopathy

Clinical Manifestation

Flu like symptoms:-Fever, pharyngitis, lymphadenopathy, mylagia.

Gastrointestinal symptoms:-Hepatitis.

Others

orchitis ( inflammation of tests).

encephalitis.

Cardiomyopathy

Clinical Manifestation Cont.

Cardiac & Respiratory symptoms:-

Change in exercise tolerance, fatigue, dry cough, dyspnea, orthopnea, palpitation, and anorexia.

Signs

Tachycardia, oedema, weak peripheral pulses, pallor, hepatomegaly, jugular venous distention, dysrhythmias.

Cardiomyopathy

Diagnostic StudiesPatients history.

Chest x- ray show cardiomegaly.

ECG reveals tachycardia, and ST segment elevation, T Wave flattening or inversion. Ventricular arrhythmia’s

Echocardiography.

Thickness of the heart muscle can be measured.

Cardiac catheterisation and coronary angiography.

CardiomyopathyComplicationsEmbolus formation

Decrease ejection fraction allow stasis of blood to occur in Lt ventricle.

Thrombus may lodged in spleen kidney, extremities, cerebral or coronary circulation.

Dysarrhythmias

Sudden cardiac death.

Causes

Ischemic heart disease, electrolyte imbalance

( hypokalemia, Hyponatremia)

Cardiomyopathy

Management

1. Hemodynamic Management

Diuretic therapy to reduce intravascular

volume.

Potassium supplements or potassium

sparing diuretics.

Nitrates which reduce venous return to the heart.

Cardiomyopathy

Management

Hemodynamic Management Cont.

Sodium nitroprusside ( Nipride)

To treat the lowering in cardiac output.

It is given in the dosage of 100 mg in 250 ml

of 5% dextrose and started at 20

mcg/kg/minute.

Cardiomyopathy

Management Cont.

2. Enhancing Contractility

E.g. Dopamine

It improves the contractility by intracellular release and utilization of calcium.

3. Cardiac Transplantation

CardiomyopathyNursing Management

Alteration in cardiac output related to decreased ventricular function.

Outcome criteria Nursing Intervention

Patient will have adequate cardiac output

Assess mental status every hour

Measure and record U/every hour

Maintain intake and output

Weigh and record the weight daily

Administer O2 & medication

Limit the activity of the patient.

CardiomyopathyNursing Management

Alteration in Cardiac output related to Dysarrhythmias.

Outcome criteria Nursing Intervention

Preventive treatment of dysrhythmias for high risk pt.

Assess and record ECG

Assess serum potassium levels

Assess pt. Mental status & VS

Support O2 and circulation

Evaluate pt. Response to therapy

Administer antiarrhythmic drugs.Provide a quit environment in an effort .

Cardiomyopathy

Nursing Management

Potential or actual ineffective coping related to life threatening illness.

Outcome criteria Nursing Intervention

Patient will participate in his own care

Assess the pt ability to cope e illness

Listen to the pt. & answer question

Explain about disease & outcome

Provide flexible visiting hours

Provide diversion activities.

Provide adequate rest & sleep

CardiomyopathyNursing Management

Activity intolerance related to low cardiac output.

Outcome criteria Nursing Intervention

Patient will have little or no discomfortPatient will not develop skin break down

Assess patients level of comfort and report s&s of discomfort

Monitor signs of skin break down.

Turn and change position every 2 hours

Limit the activity.

Plan and provide adequate rest.

CardiomyopathyNursing Management

Alteration in fluid volume: Excess related to ventricular dysfunction

Outcome criteria Nursing Intervention

Oedema is reduced Maintain normal body weight.Maintain balance between intake and out put

Assess CVP.

Check weight.

Maintain intake and output change

Administer diuretics as ordered.