What am I?
cardiomyopathy
A subacute or chronic disorder of the
heart muscle. Treatment is palliative
not curative. The client will have many
changes to lifestyle and lifespan.
Physiology:
Dilated cardiomyopathy: Fibrosis of
the myocardium and endocardium,
dilated chambers, mural wall thrombi
prevalent.
Non-obstructive cardiomyopathy:
Hypertrophy of the walls,
hypertrophied septum, small chamber
size .
Obstructive cardiomyopathy: Same
as non obstructed except for
obstruction in the left ventricular wall.
Restrictive cardiomyopathy: Mimics
pericarditis, fibrosed walls can
expand or contract, emboli is
common.
Causes:
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Genetic conditions.
Long-term high blood
pressure.
Heart tissue damage from a
previous heart attack.
Chronic rapid heart rate.
Heart valve problems.
Metabolic disorders, such as
obesity, thyroid disease or
diabetes.
Dilated cardiomyopathy
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Cardiac glycoside
Diuretic
Angiotensin-converting
enzyme inhibitor, such as
Oxygen
Antiarrhythmics
Beta-adrenergic blockers,
Aldosterone antagonist,
Vasodilator
Angiotensin II receptor
blocker
Inotropic agent
Anticoagulant
Interventions/Teaching:
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Low-sodium, low fat
Fluid restriction
Avoid alcohol
Rest periods
Moderate exercise to prevent
deconditioning
Cardiac rehabilitation
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CNS: Fatigue and weakness
Heart: HF, dysrhythmias and heart
block, systemic or pulmonary emboli,
s3, s4 gallop, cardiomegaly
Non obstructive cardiomyopathy
RESP: Dyspnea
Heart: Angina , mild cardiomegaly, s4
gallop, ventricular dysrhythmias,
sudden death, HF Fatigue, syncope
obstructive cardiomyopathy
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RESP: Dyspnea
Heart: Angina , mild cardiomegaly, s4
gallop, ventricular dysrhythmias,
sudden death, HF Fatigue, syncope, ❖
mitral regurgitation, A- FIB
obstructive cardiomyopathy
RESP: Dyspnea
Heart: Mild cardiomegaly, s4 / s3
gallop, Fatigue, heart block, emboli
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Treatments
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Medications:
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Labs & Diagnostics
Assessment:
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Dilated cardiomyopathy:
Symptomatic treatment of
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HF, vasodilators, heart
transplant , control
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dysrhythmias.
Nonobstructed
cardiomyopathy:
Symptomatic treatment, beta
blockers, cardioversion,
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ventricular myotomy, valve
replacement, digoxin, nitrates,
vasodilators.
obstructive
cardiomyopathy:
Symptomatic treatment, beta ❖
blockers, cardioversion,
ventricular myotomy, valve
replacement, digoxin, nitrates,
vasodilators.
Restrictive cardiomyopathy:
Supportive treatment for
symptoms, treatment of
hypertension,conversion,
exercise restrictions
emergency treatment of acute
pulmonary edema.
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Plasma brain natriuretic peptide
Levels may reveal heart failure and its
severity used as an ongoing tool to
help to monitor the response to
treatment.
Serum troponin, creatine kinase
(CK), and CK-MB levels may be
acutely elevated if the patient has
myocarditis or acute coronary
syndrome.
Liver function tests May be
elevated.
B-type natriuretic peptide Levels
identify the presence and severity of
fluid overload.
Urine toxicology screening May
detect drugs leading to
cardiomyopathy.
Elevated creatinine May be related
to hypovolemia or ACE inhibitors as
etiology.
Angiography Results rule out
ischemic heart disease.
Chest radiography Demonstrates
moderate to marked cardiomegaly
and possible pulmonary edema.
Echocardiography May reveal
ventricular thrombi, global
hypokinesis, and the degrees of left
ventricular dilation and systolic
dysfunction.
Gallium scanning May identify
patients with dilated cardiomyopathy
and myocarditis.
Cardiac catheterization Can show
left ventricular dilation and
dysfunction, elevated left ventricular,
right ventricular filling pressures, and
diminished cardiac output.
Transvenous endomyocardial
biopsy May be used in determining
the underlying cause in some
patients (cardiac transplant patients)
including myocarditis, connective
disorders and amyloidosis.
Electrocardiography Identifies
arrhythmias and intraventricular
conduction defects, and may reveal
nonspecific ST-T wave changes and
Q waves.
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