Cardiomyopathy

Cardiomyopathy

1. CARDIOMYOPATHY Mrs. D. Melba Sahaya Sweety M.Sc Nursing GIMSAR

2. Introduction Cardiomyopathy  is a group of diseases that affect the heart muscle.Early on there may be few or no symptoms. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure. An irregular heartbeat and fainting may occur. Those affected are at an increased risk of sudden cardiac death.

3. Definition   Cardiomyopathy is a type of heart disease in which the heart muscle is abnormal enlarge thickened and stiffened as a result the heart muscle ability to pump blood is usually impaired . JOYCE M BLACK

4. Definition Cardiomyopathy is a wakening of heart muscle or a change in heart muscle structure ,it is often associated with inadequate heart pumping or other function heart problem . BRUNNER AND SIDDHARTH

5. 2006 AHA defined cardiomyopathies as “a heterogeneous group of diseases of the myocardium associated with mechanical &/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and are due to a variety of causes Definition

6. Incidence  Prevalence of Dilated Cardiomyopathy is 36 per 100,000 population Third most common cause of heart failure Most frequent cause of heart transplantation Complete recovery is rare 50% die within 2yrs and 25% survive longer than 5yrs

7. Types of Cardiomyopathies The World Health Organization has classified into three major Types: 1.Dilated Cardiomyopathy 2.Hypertrophic Cardiomyopathy 3.Restrictive Cardiomyopathy

8. Arrhythmogenic right ventricular dysplasia (ARVD) Peripartum cardiomyopathy Alcoholic cardiomyopathy Ischemic cardiomyopathy Noncompaction cardiomyopathy , also called spongiform cardiomyopathy Idiopathic cardiomyopathy , Other Types of Cardiomyopathies

9. Arrhythmogenic right ventricular dysplasia (ARVD) is a very rare form of cardiomyopathy , but it’s the leading cause of sudden death in young athletes. In this type of genetic cardiomyopathy , fat and extra fibrous tissue replace the muscle of the right ventricle. This causes abnormal heart rhythms. Other Types of Cardiomyopathies

10. Peripartum cardiomyopathy  occurs during or after pregnancy. This rare type occurs when the heart weakens within five months of delivery or within the final month of pregnancy. When it occurs after delivery, it’s sometimes called postpartum cardiomyopathy . This is a form of dilated cardiomyopathy , and it’s a life-threatening condition. There’s no cause. Other Types of Cardiomyopathies

11. Alcoholic cardiomyopathy  is due to drinking too much alcohol over a long period of time, which can weaken your heart so it can no longer pump blood efficiently. Your heart then becomes enlarged. This is a form of dilated cardiomyopathy . Other Types of Cardiomyopathies

12. Ischemic cardiomyopathy  occurs when your heart can no longer pump blood to the rest of your body due to  coronary artery disease . Blood vessels to the heart muscle narrow and become blocked. This deprives the heart muscle of oxygen. Ischemic cardiomyopathy is a common cause of heart failure. Alternatively, nonischemic cardiomyopathy is any form that isn’t related to coronary artery disease Other Types of Cardiomyopathies

13. Noncompaction cardiomyopathy , also called spongiform cardiomyopathy , is a rare disease present at birth. It results from abnormal development of the heart muscle in the womb. Diagnosis may occur at any stage of life. When cardiomyopathy affects a child, it’s called pediatric cardiomyopathy . If you have Idiopathic cardiomyopathy , it means there’s no known cause. Other Types of Cardiomyopathies

14. 1.Dilated Cardiomyopathy The most common form, dilated cardiomyopathy (DCM), occurs when the heart muscle is too weak to pump blood efficiently. The muscles stretch and become thinner. This allows the chambers of the heart to expand. This is also known as enlarged heart. You can inherit it, or it can be due to coronary artery disease.

15. Etiology 1.Dilated Cardiomyopathy Genetics Infections like HIV and other viruses Hypertension Autoimmune diseases Nutritional deficiencies Heart Valve Disorders Myocardial Infraction Chronic Alcohol/ Cocaine Use Neuromuscular Disorders

16. Hypertensive cardiomyopathy - seen in people who have high BP for a long time, particuarly when it has gone untreated for years. Infectious cardiomyopathy - HIV, viral myocarditis Toxic cardiomyopathy – due to cocaine, amphetamines, and some chemotherapy drugs (doxorubicin, daunorubicin )  Types of Dilated Cardiomyopathies

17. Pathophysiology 1.DilatedCardiomyopathy Due to etiological factors Characterized by diffuse inflammation and rapid degeneration of myocardial fibers and Decreased contractility Ventricles dilates to increase contractility from stretched muscle fibers Increased ventricular radius results in increased wall tension Increased cardiac workload and impairment of systolic function Decreased cardiac output Atrial enlargement and stasis of blood in the left ventricle leads to cardiomegaly Increased Sympathetic outflow to increase HR,SVR Results in stroke volume Falls

18.  Decreased exercise capacity Fatigue Dyspnea Paroxysmal nocturnal dyspnea Orthopnea As the disease progresses, Dry cough, Palpitations Clinical Manifestation 1.DilatedCardiomyopathy Abdominal bloating Nausea, vomiting anorexia Abnormal S3 and S4 sound Tachycardia or bradycardia Edema Pulmonary crackles Weak peripheral pulses Hepatomegaly Jugular venous distension

19. Diagnostic Evaluation 1.DilatedCardiomyopathy  History Collection – regarding previous history of cardiac disease, alcoholism, nutritional deficiencies, autoimmune diseases etc… Physical Examination - check for week peripheral pulse, hepatomegaly , jugular vein distension etc.. Blood tests .  To reveal an infection, a metabolic disorder or toxins in the blood that can cause dilated cardiomyopathy . ECG - reveals tachycardia, bradycardia and dysarrythmias .

20. Echocardiography - shows left ventricular dilatation with normal or thinned walls and reduced ejection fraction. Cardiac catheterization and coronary angiography - it is performed to confirm CAD Diagnostic Evaluation 1.DilatedCardiomyopathy

21. Diagnostic Evaluation 1.DilatedCardiomyopathy Chest x-ray - shows the signs of cardiomegaly Genetic testing -shown that gene mutations in the TTN gene

22. Nitrates: eg - isosorbitrate Loop diuretics: eg-furosemide ACE inhibitors: eg - captopril Beta adrenergic blockers: eg - atenolol Aldosterone agonists: eg - spironolactone Cardiac glycoside : eg-digoxin Anticoagulation therapy Pharmachological Management 1.DilatedCardiomyopathy

23. Surgical Management 1.DilatedCardiomyopathy Biventricular pacemaker   This device sends out electrical signals to control contractions between the heart's left and right ventricles.

24. Implantable cardioverter -defibrillators (ICD).  An ICD monitors your heart rhythm and delivers electrical shocks when needed to control abnormal, rapid heartbeats, including those that cause the heart to stop. An ICD can also function as a pacemaker. SurgicalManagement 1.DilatedCardiomyopathy

25. Left ventricular assist devices (LVAD).   This mechanical device is implanted into the abdomen or chest and attached to a weakened heart to help it pump. An LVAD may be used as a long- or short-term therapy for people waiting for a heart transplant. They usually are considered after less invasive approaches are unsuccessful Surgical Management 1.DilatedCardiomyopathy

26. Heart transplant A heart transplantion is done if medications and other treatments for dilated cardiomyopathy no longer work . Surgical Management 1.DilatedCardiomyopathy

27. Heart failure.  In dilated cardiomyopathy , the heart might not be able to supply body with the blood it needs to work properly, leading to heart failure. Fluid can build up in the lungs, abdomen, legs, ankles and feet. Heart valve regurgitation.  Enlargement of the left ventricle may make it harder the heart valves to close, causing a backward flow of blood and making the heart pump less effectively. Heart rhythm problems.   Changes in heart's structure and changes in pressure on the heart's chambers can lead to the development of abnormal heart rhythms (arrhythmias). Sudden cardiac arrest .  Dilated cardiomyopathy can cause the heart to suddenly stop beating. Blood clots (emboli).   Pooling of blood in the left ventricle can lead to blood clots, which may enter the bloodstream and cut off the blood supply to vital organs. These blood clots can cause stroke, heart attack or damage to other organs. Arrhythmias can also cause blood clots. Complications of DilatedCardiomyopathy

28. 2.Hypertrophic Cardiomyopathy Hypertrophic cardiomyopathy (HCM) is a disease in which the heart muscle becomes abnormally thick (hypertrophied). The thickened heart muscle can make it harder for the heart to pump blood

29.   2.Hypertrophic Cardiomyopathy Genetic Factors Hereditary Disorders It can also be caused by long-term high blood pressure or aging.  Diabetes  or thyroid disease can also cause hypertrophic cardiomyopathy . There are other instances that the cause is unknown. Etiology

30. Types of Hypertrophic Cardiomyopathies 1.) Obstructive type In obstructive HCM, the wall (septum) between the two bottom chambers of the heart thickens. The walls of the pumping chamber can also become stiff. It may block or reduce the blood flow from the left ventricle to the aorta. Most people with HCM have this type. 2.) Non-obstructive type In nonobstructive HCM, the heart’s main pumping chamber still becomes stiff. This limits how much blood the ventricle can take in and pump out, but blood flow is not blocked

31. Pathophysiology 2.Hypertrophic Cardiomyopathy Due to etiological factors Thickened intra-ventricular septum and ventricular wall ventricular hypertrophy  LV outflow obstruction   Diastolic dysfunction I mpaired ventricular filling and decreased outflow Decreased cardiac output  Non uniform ventricular contraction and cause High systolic contraction  Increased pulmonary venous pressure and Myocardial Ischemia    Elevated intra-ventricular pressures Increased myocardial wall stress Increased oxygen demand  

32. Chest pain   or pressure that usually occurs with exercise or physical activity, but also may occur with rest or after meals. Shortness of breath and fatigue ,  especially with exertion. These symptoms are more common in adults with hypertrophic cardiomyopathy and are most likely caused by a backup of pressure in the left atrium and lungs. Syncope  (fainting or passing out) may affect HCM patients. Syncope with HCM may be caused by irregular heart rhythms, abnormal responses of the blood vessels during exercise, or no cause may be found. Clinical Manifestation 2.Hypertrophic Cardiomyopathy

33. Palpitations   (fluttering in the chest) due to abnormal heart rhythms (arrhythmias) such as atrial fibrillation or ventricular tachycardia. Atrial fibrillation occurs in about 25 percent of those with HCM, and increases the risk for blood clots and heart failure. Dizziness Lightheadedness Swelling in the ankles, feet, legs, abdomen and veins in the neck Clinical Manifestation 2.Hypertrophic Cardiomyopathy

34. History Collection:  ask questions about Patient symptoms and family history. Physical exam:   Ascultate heart and lungs. Patients with hypertrophic obstructive cardiomyopathy (HOCM) may have a heart murmur. Echocardiogram : It is the most common test used to diagnose HCM, as the characteristic thickening of the heart walls is usually visible on the echo . E lectrocardiogram: They measure electrical signals from your heart. An ECG can show abnormal heart rhythms and signs of heart thickening . Diagnostic Evaluation 2.Hypertrophic Cardiomyopathy

35. Magnetic resonance imaging (MRI ).  It gives information about the heart muscle and shows how the heart and heart valves work. This test is often done with an echocardiogram .   Cardiac catheterization : catheters can be placed in the left ventricle and the ascending  aorta, to measure the pressure difference between these structures. Diagnostic Evaluation 2.Hypertrophic Cardiomyopathy

36. Beta blockers such as metoprolol , propranolol or atenolol Calcium channel blockers such as verapamil or diltiazem Heart rhythm drugs such as amiodarone or disopyramide Blood thinners such as warfarin , dabigatran , rivaroxaban or apixaban to prevent blood clots if you have atrial fibrillation Pharmachoogical Management of Hypertrophic Cardiomyopathy

37. Surgical Management of Hypertrophic Cardiomyopathy   S eptal myectomy : A surgical procedure, the surgeon removes a small amount of the thickened septal wall to widen the outflow tract (the path the blood takes) from the left ventricle to the aorta. Myectomy is considered when medications are not effective in treating HCM. This frequently eliminates the mitral valve regurgitation.

38. Surgical Management of Hypertrophic Cardiomyopathy Ethanol Ablation This procedure, also called septal ablation, is reserved for patients who are not eligible candidates for septal myectomy . The ablation procedure is performed in the cardiac catheterization laboratory. A balloon catheter is inserted into the artery and inflated. A contrast agent is injected to locate the thickened septal wall that narrows the passageway from the left ventricle to the aorta. When the bulge is located, a tiny amount of pure alcohol is injected through the catheter. The alcohol kills the cells on contact, causing the septum to shrink back to a more normal size over the following months, widening the passage for blood flow.

39. Implantable cardioverter -defibrillator (ICD).  An ICD is a small device that continuously monitors your heartbeat. It's implanted in your chest like a pacemaker. If a life-threatening arrhythmia occurs, the ICD delivers precisely calibrated electrical shocks to restore a normal heart rhythm. ICD has been shown to help prevent sudden cardiac death, which occurs in a small number of people with hypertrophic cardiomyopathy . Surgical Management of Hypertrophic Cardiomyopathy

40. Heart transplantion – In HCM patients with advanced, end-stage disease, a heart transplant may be considered. In this procedure, a person’s diseased heart is replaced with a healthy donor heart. Surgical Management of Hypertrophic Cardiomyopathy

41. Complications of Hypertrophic Cardiomyopathy Atrial fibrillation.   Thickened heart muscle, as well as the abnormal structure of heart cells, can cause changes in the heart's electrical system, resulting in fast or irregular heartbeats. Atrial fibrillation can also increase your risk of developing blood clots, which can travel to your brain and cause a stroke. Blocked blood flow.   In many people, the thickened heart muscle blocks the blood flow leaving the heart, causing shortness of breath with exertion, chest pain, dizziness and fainting spells . Mitral valve problems.  If the thickened heart muscle blocks the blood flow leaving the heart, the valve between the left atrium and left ventricle (mitral valve) may not close properly. As a result, blood can leak backward into the left atrium (mitral valve regurgitation), possibly leading to worsening symptoms.

42. Dilated cardiomyopathy .   In a very small number of people with HCM, the thickened heart muscle may become weak and ineffective. The ventricle becomes enlarged (dilated), and its pumping ability becomes less forceful. Heart failure.   The thickened heart muscle can eventually become too stiff to effectively fill the heart with blood. As a result, your heart can't pump enough blood to meet your body's needs. Sudden cardiac death.   Rarely, hypertrophic cardiomyopathy can cause heart-related sudden death in people of all ages. Because many people with hypertrophic cardiomyopathy don't realize they have it, sudden cardiac death may be the first sign of a problem. It can happen in seemingly healthy young people, including high school athletes and other young, active adults. Complications of Hypertrophic Cardiomyopathy

43. 3.Restrictive Cardiomyopathy Restrictive cardiomyopathy Restrictive cardiomyopathy , the rarest form of cardiomyopathy , is a condition in which the walls of the lower chambers of the heart (the ventricles) are abnormally rigid and lack the flexibility to expand as the ventricles fill with blood. The pumping or systolic function of the ventricle may be normal but the diastolic function (the ability of the heart to fill with blood) is abnormal. Therefore, it is harder for the ventricles to fill with blood, and with time, the heart loses the ability to pump blood properly leading to  heart failure .

44. 3.Restrictive Cardiomyopathy Amyloidosis Radiation to the thorax Inborn errors of metabolism Endocardial Fibrosis Loffler syndrome Sarcoidosis Hemochromatosis Etiology

45. Amyloidosis ,   an abnormal build up of protein in organs and tissues. This is the most common cause of RCM. Hemochromatosis ,  a condition that occurs from an iron overload in the heart and body Sarcoidosis ,   a disease that causes scarring of the heart Eosinophilic endomyocardial disease ,  a disease caused by certain tumors , lymphomas, or parasitic disease Scleroderma,  a disease that causes hardening of tissues in the body Radiation-induced heart disease ,  a condition that may occur from cancer radiation treatment Certain rare genetic conditions.  You may have increased risk if you have a family member with RCM. Etiology of Restrictive Cardiomyopathy

46. Pathophysiology 3 .Restrictive Cardiomyopathy Due to etiological factors Rigid myocardium   Increased Diastolic Ventricular pressure Decreased Ventricular filling Decreased cardiac output Weakness Fatigue   Heart failure    Venous congestion   Jugular venous distention Hepatomegaly Ascites

47. Shortness of breath when lying flat (at first with exercise; but over time it occurs at rest) Fatigue (feeling overly tired) Inability to exercise Swelling of the legs and feet, hepatomegaly,acetitis Weight gain Weakness or lightheadedness Cough Nausea, bloating, and poor appetite (related to fluid retention) Palpitations (fluttering in the chest due to abnormal heart rhythms) Clinical Manifestation 3 .Restrictive Cardiomyopathy

48. Electrocardiogram (ECG) , to check the heart rhythm ECG monitoring , to look at heart rhythms Chest X-ray , to see the heart size and anatomy Blood tests , to help assess the type of RCM Echocardiogram , to examine blood flow in the heart and how well the heart pumps blood to the body Exercise testing , to see how your heart does during exercise Cardiac MRI , to further look at heart anatomy and coronary arteries Heart biopsy , to look at a small tissue sample from the heart in more detail Cardiac catheterization  with coronary angiography. This looks at the arteries in special cases, as well as measures pressures within the heart. Diagnostic Evaluation 3 .Restrictive Cardiomyopathy

49. Water pills (diuretics) to reduce swelling Medicine such as rate-lowering calcium channel blockers ( verapamil or diltiazem )or beta-blockers ( metoprolol , propranolol ) to reduce the heart’s workload and increase its efficiency Medicine such as ACE inhibitors to help the heart pump better   benazepril , captopril , lisinopril , enalapril . Blood thinners (anticoagulants) to prevent blood clots if you have certain abnormal heart rhythms Example warfarin , dabigatran , rivaroxaban or apixaban Medicine to help prevent abnormal heart rhythms Pharmacological Management 3 .Restrictive Cardiomyopathy

50. Heart transplant . This may be considered in advanced cases Surgical Management of Restrictive Cardiomyopathy Compication of Restrictive Cardiomyopathy Same as Dilated cardiomyopathy

51. Lifestyle Changes of Cardiomyopathy The doctor may recommend lifestyle changes to manage a condition that is causing the cardiomyopathy . These changes may help reduce symptoms. Lifestyle changes may include: Quitting smoking Losing excess weight Eating a low-salt diet Getting moderate exercise, such as walking, and avoiding strenuous exercise Avoiding the use of alcohol and illegal drugs Getting enough sleep and rest Reducing stress Treating underlying conditions, such as diabetes and high blood pressure

52.   Maintain Normal Cardiac Function, Increasing activity tolerance, relieve anxiety. Assess for abnormal heart and lung sounds. Monitor for any complication Monitoring vital signs and symptoms of heart failure . Advice to take proper nutrition Provide emotional support and relieve anxiety Avoid the strenuous exercise and dehydration Monitor urine output, noting decreasing output and concentrated urine. Nursing Management of Cardiomyopathy

53. Decreased Cardiac Output related to impaired myocardial contractility as manifested by tachycardia, dysrhythmias , Orthopnea , JVD, liver engorgement, edema  Ineffective cardiopulmonary, cerebral, peripheral, and renal tissue perfusion related to decreased peripheral blood flow (resulting from decreased cardiac output)as evidenced by weak peripheral pulse, edema,palpitation . Impaired gas exchange related to alveolar edema due to increased intra ventricular pressure as evidenced by shortness of breath,spo2 level of 85% and crackle upon auscultation Nursing Diagnosis for Cardiomyopathy

54. Excess fluid volume related to pulmonary venous congestion and Changes in glomerular filtration rate as manifested by Oliguria , edema , JVD, and hepatomegaly Fatigue related to decreased cardiac output as manifested by weakness, limited range of motion  Anxiety related to fear of death, surgical procedures, and hospitalization as manifested by facial expresion,depression Nursing Diagnosis for Cardiomyopathy