CARDIOMYOPATHY

CARDIOMYOPATHY
- A heart muscle disease of unknown cause
(idiopathic)

Classifications:
• Primary (Idiopathic)
• Secondary – has an underlying pathologic
condition that resulted to cardiomyopathy
Types:
1. DILATED (CONGESTIVE) CARDIOMYOPATHY
- Characterized by significant dilation of the
ventricles without significant hypertrophy
 TYPES OF DILATED CM
❖ Ischemic CM

❖ Idiopathic CM

❖ Hypertensive CM

❖ Infectious CM

❖ Alcoholic CM

❖ Toxic CM

❖ Peripartum CM

❖ Tachycardia-mediated CM
 Pathophysiology
Ventricular dilation
↓
Degeneration of myocardial fiber
↓
• Decreased Ejection Fraction
• Pooling of blood leading to mural thrombi
• Altered valve function

↓
↓Stroke volume/ ↓C.O.
↓
Heart Failure
Signs and Symptoms: fatigue, weakness, left-sided HF,
narrowed pulse pressure, S3-S4 gallops, murmur,
chest pain

Dx: Echocardiography, ECG, CXR, Cardiac

Catheterization
Tx: Correct the causative factor; symptomatic
treatment of heart disease; Control of dysrhythmias

Drugs: digitalis, diuretics, anticoagulants,

vasodilators, antiarrhythmics

Sx: Heart Transplant (Orthotopic)

Pacemakers
 2. HYPERTROPHIC CARDIOMYOPATHY
(Hypertrophic Subaortic Stenosis)
- Characterized by enlargement of the heart
muscle especially the interventricular septum
Types of Hypertrophic CM:
❖ Obstructive

❖ Non-obstructive
 Pathophysiology
Ventricular and septal hypertrophy
↓
• ↓Ventricular filling
• ↓ Effectiveness of contraction
• Narrowed coronary arterioles (multiple small areas
of ischemia and necrosis)
↓
Impeded ventricular contraction
↓Stroke volume/ ↓C.O.
↓
Arrhythmia and/or Heart Failure
S/sx: Dyspnea, angina, syncope, fatigue,
palpitation, mild cardiomegaly, sudden death
(common); heart failure

Dx: Echocardiography, CXR, ECG, Angiography,

Cardiac catheterization
Tx:
• Symptomatic treatment
• Drugs: Beta blockers, calcium-channel blockers,
anticoagulants. Vasodilators, digitalis, nitrates
and other inotropic agents are contraindicated
• Conversion of atrial fibrillation
• Defibrillation when emergency atrial fibrillation
occurs
Sx:

Venctirculomyotomy (myectomy)

Cardiomyoplasty
 3. RESTRICTIVE CARDIOMYOPATHY
- Characterized by an impairment of ventricular stretch
caused by fibrosis and thickening and rigidity of
ventricular walls

S/sx: PND, Dyspnea, fatigue, heart failure,

mild/moderate cardiomegaly, S3-S4 gallops, heart block

Dx: Radionuclide imaging;

Echocardiography

Tx: Exercise restriction, treatment of HF, supportive

treatment of symptoms, conversion of dysrhythmias
ARRYTHMOGENIC RIGHT VENTRICULAR
CARDIOMYOPATHY (ARCVC)
- Heart muscle is progressively replaced by fibrous and
fatty tissue which commonly affects the Right
Ventricle

Tx: Antiarrhythmic agents, ACE inhibitiors, Diuretics and

Anticoagulants
 Pathophysiology
Infiltration and replacement by fibrous scar and
adipose tissue
↓
Initially localized
↓
Spreads and affect the entire heart
↓
Right ventricular dilation
↓
Poor contractility
↓
Arrhythmia and/or Heart Failure
 TAKO-TSUBO CARDIOMYOPATHY
(STRESS CARDIOMYOPATHY/
BROKEN HEART SYNDROME)
- Sudden weakening of the mid-section and apex of
the heart usually caused by extreme emotions and
stress

Tx: Same treatment with Acute Heart Failure

• News of an unexpected death of a loved one
• A frightening medical diagnosis
• Domestic abuse
• Losing a lot of money
• Natural disasters
• A surprise party
• Having to perform publicly
• Job loss
• Divorce
• Physical stressors, such as an asthma attack, a
car accident or major surgery
Nursing Management:
1. Avoidance of alcohol
2. Cessation of smoking
3. Restriction of NA in Diet
4. Monitor for signs and symptoms of progressive heart
failure and compromised renal perfusion
5. Nursing responsibilities with drug administration
6. Warn the patient against strenuous activity physical
activity
7. Monitor patient’s condition (VS, I&O)
8. Health teachings (for patient and family)
• Ways how to increase activity tolerance
• Reducing anxiety
• Performing emergency CPR
• Operation of defibrillator
• Exercise guideline

9. Encourage patients family members to undergo

diagnostic exam for cardiomyopathy
END