Cardiomyopathy and

Congestive Heart Failure

 Cardiomyopathy
 Disease of the heart muscle
 Cause is unknown
 Occurs in only 10-20 per 100,000
 Results in 30,000 deaths/year
 3 types
 Dilated – both ventricles
 Hypertrophic – usually die by age 40
 Restrictive – rarest
 Cardiomyopathy
 Characterized by left and right ventricular
failure
 Some may be asymptomatic for years and
others have acute onset
 Stroke volume and cardiac output are
decreased
 Atypical chest pain which occurs at rest
 Progressive and chronic disease
 Cardiomyopathy, cont.
 Signs and symptoms are dependent upon the type
 Dilated
 Dyspnea
 Fatigue
 Left sided heart failure
 Cardiomyopathy
 Mitral regurgitation (S1 and S2 sounds heard)
 Hypertropic
 Syncope
 Ankle edema
 Orthopnea
 Angina
 Restrictive
 Exercise intolerance
 Dyspnea
 Fatigue
 Right sided heart failure
 S3 and S4
 Cardiomyopathy, cont.
 Diagnosis
 Echo - primary
 Angiography
 Radionuclide imaging
 Dysrhythmias
 Decreased CO with restrictive
 Cardiomyopathy, cont
 Interventions
 Drugs
 Diuretics, vasodilators, cardiac glycosides, beta
blockers, anticoagulants
 Surgery
 Excision of the hypertrophied muscle
 Mitral valve replacement
 Cardiomyoplasty – chest muscle wrapped around the
heart
 Heart transplant
 Nursing Care
 Assess
 Dyspnea
 Cough
 Edema
 Dysrhythmias
 Decreased CO
 Need lots of family support and teaching about the
disease
 Heart Transplant
 Transplanted form a donor with comparable weight
and ABO compatibility into a recipient less than 6
hours after procurement
 Donor must be free of infection, no chest trauma and
be declared brain dead, and no malignancies
 Most of the cases of transplant are to patients with
cardiomyopathy
 Patients with a history of noncompliance, depression
or inability to cope with stress are not considered
good candidates
 Heart Transplant, cont.
 Recipient is prepared for Open Heart Surgery and placed on
cardiopulmonary bypass and the anterior portions of the
patients heart are removed and replaced with the donor heart
 Post op care is similar to CABG patients
 Must be protected from infection by isolation
 Must receive immunosuppressant drugs for life, as well as
steroids (Solu-Medrol, CellCept, Prograf, Imuran,
Sandimmune)
 Watch for rejection – temp, malaise, fatigue, dysrhythmias
 Monitored by endocardial biopsies
 Complications include
 Hypertension, ^ cholesterol, obesity, and malignancies
Congestive Heart Failure/Left Sided
Heart Failure
 Causes the most hospitalizations in patients over the age of 65
 5 million people on the US are living with heart failure
 Inadequacy of the heart to pump blood throughout the body effectively
 This deficit causes insufficient perfusion of body tissues with nutrients and
oxygen
 Causes of heart failure
 Coronary artery disease
 Acute MI
 Cardiomyopathy
 Hypertension
 COPD
 Anemia
 Fluid volume overload
 Disease of the heart valves
 CHF, cont.
 2 ventricles pump independently
 Can have right or left sided failure
 Usually the left side fails 1st and progresses to failure
of both ventricles
 May be acute or chronic
 May be mild or severe
 May be systolic or diastolic failure
 May cause pulmonary edema or enlarged liver
 Causes retention of sodium and water by the kidneys
 CHF, cont.
 Right sided failure
 May be caused by left ventricle failure, RV infarct, or
Pulmonary hypertension
 Right ventricle is unable to empty completely
 Increased volume and pressure develops in the systemic
veins and systemic vascular congestion develops with
peripheral edema
 Patient may gain fluid weight and have nausea/anorexia,
ascites may develop
 High output failure
 Caused by increased metabolic needs
 Septicemia, anemia, and hyperthyroidism
 CHF, cont.
 Compensation – how the body responds to
maintain adequate cardiac output
 Sympathetic
 Renal
 Ventricular hypertrophy
 CHF, cont.
 Diagnostic tests
 History and physical
 Chest x-ray shows cardiomegaly with hazy lung fields
 Echocardiogram will show enlarged heart and poor
contraction of ventricles
 BUN and creatinine ^
 Na and Hct may be decreased due to dilution
 SAO2 may be decreased
 LFT’s may be elevated
 B-type Natriuretic peptide (BNP) – produced and released
by the ventricles increases
 CHF, cont.
 Objective symptoms  Objective symptoms
 Left sided failure  Right sided failure
 Anxious  Weight gain
 Pale  Pitting, dependent edema
 Tachycardia  JVD
 Dyspnea, with crackles,  Ascites
wheezes  Decreased UOP
 Orthopnea  Distended neck veins
 Non-productive cough  N/V, anorexia
 Later productive cough
with frothy, bloody
sputum
 Oliguria
 Nursing Assessment
 Vital signs with both apical and radial pulse
 HOB elevated
 Peripheral pulses
 JVD
 CVP
 Orientation with GCS
 Assess for crackles and wheezes
 Dependent edema
 Weight
 Accurate I/O
 Abdominal girth
 Assess for client and family emotional status
 CHF, cont.
 Medical treatment
 Treat the cause – hypertension, rhythm problems, valve
repair
 Drugs – cardiac glycosides, diuretics, inotropic agents,
vasodilators, ACE inhibitors, beta blockers, Natrecor
 Diet – restrictions of sodium and increase of K if diuresis is
occuring
 Restriciton of H2O
 Surgery
 Cardiomyoplasty
 Heart transplant
 Heart reduction surgery
 Nursing Interventions
 Client education for home care
 Must adjust lifestyle
 May need O2
 S/S to report to provider
 Weight control – contact physician if more than 2 lb weight gain in a
week
 Dietary management
 Medication review
 Exercise regimen
 Need to work with client to balance activity and rest periods
 Monitor for complications
 Many have outpatient CHF clinics