1. Cardiomyopathy Prepared By Dr. Hanan Said Ali

2. 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.

3. Cardiomyopathy Definition is a heart muscle disease associated with cardiac dysfunction. Cardiomyopathy may lead to severe heart failure, dysrhythmias.

4. Cardiomyopathy Classification of cardiomyopathy Primary There is primary structural and functional disability of the myocardium The heart muscle is the only structure affected and other cardiac structure are not affected. Secondary Is usually precipitated by a cause, such as ischemia, viral infection, alcohol intake, drug abuse or pregnancy

5. Cardiomyopathy Classification according to anatomic and Pathophysiologic process 1. Hypertrophic Cardiomyopathy It is recognized by inappropriate left ventricular hypertrophy, decreased cardiac output and outflow obstruction. 2. Restrictive Cardiomyopathy It is characterized by myocardial muscle mass. There is impairment of diastolic filling of the heart. It due to ventricular thrombosis

6. 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.

7. 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.

8. Cardiomyopathy Clinical Manifestation Flu like symptoms:- Fever, pharyngitis, lymphadenopathy, mylagia. Gastrointestinal symptoms:- Hepatitis. Others orchitis ( inflammation of tests). encephalitis.

9. 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.

10. Cardiomyopathy Diagnostic Studies Patients 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.

11. Cardiomyopathy Complications Embolus 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)

12. 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.

13. 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.

14. Cardiomyopathy Management Cont. 2. Enhancing Contractility E.g. Dopamine It improves the contractility by intracellular release and utilization of calcium. 3. Cardiac Transplantation

15. Cardiomyopathy Nursing Management Alteration in cardiac output related to decreased ventricular function. Outcome criteriaNursing 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.

16. Cardiomyopathy Nursing Management Alteration in Cardiac output related to Dysarrhythmias. Outcome criteriaNursing 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.

17. Cardiomyopathy Nursing Management Potential or actual ineffective coping related to life threatening illness. Outcome criteriaNursing 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

18. Cardiomyopathy Nursing Management Activity intolerance related to low cardiac output. Outcome criteriaNursing Intervention  Patient will have little or no discomfort  Patient 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.

19. Cardiomyopathy Nursing Management Alteration in fluid volume: Excess related to ventricular dysfunction Outcome criteriaNursing 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.