Cardiomyopathy.pptx

For 2nd year B.Sc. Nursing students

1. CARDIOMYOPATHY Presented By: Mr. Nandish.S Asso. Professor Mandya Institute of Nursing Sciences

2. DEFINITION : It is a disease of the heart muscle that is associated with cardiac dysfunction. It is a term used to describe a group of heart muscle diseases that primarily affect the structural or functional ability of the myocardium. It is a disease of heart muscle in which heart loses its ability to pump blood effectively.

3. INCIDENCE : Dilated cardiomyopathy is the most common form affects 5 to 7 in 100,000 adults and 0.50 in 100,000 children. Hypertrophic cardiomyopathy is the leading cause of sudden death with an incidence of 1 in 500 persons (Athletes) & 0.2% in general population. Restrictive cardiomyopathy is the rarest form, it accounts 5% of all cardiomyopathy cases.

4. GENERAL CLASSIFICATION : Primary CMP : these are conditions in which the etiology of the heart disease is unknown. Heart muscles are the only part involved in this type and other portions remain normal. Secondary CMP : here the cause of myocardial disease is known and are due to another disease process. They are not limited to heart muscles.

5. WHO CLASSIFICATION : Dilated / Congestive CMP Restrictive CMP Hypertrophic CMP Arrhythmogenic Right Ventricular CMP Unclassified CMP

6. DILATED CMP: It is the most common condition characterized by ventricular dilation, impairment of systolic function, atrial enlargement and stasis of blood in Left Ventricle. It is the result of primary ventricular dilation.

7. Etiology : Idiopathic Cardiotoxic agents : Alcohol, cocaine, Doxorubicin Genetic or familial history Coronary artery disease (CAD) Metabolic disorders Muscular Dystrophy Myocarditis Pregnancy Valvular disorder

8. Pathophysiology : Due to etiology Diffuse inflammation & rapid degeneration of myocardial fibres Ventricular dilation Impairment of systolic function Atrial enlargement & stasis of blood in the left ventricle Cardiomegaly

9. Symptoms : Change in exercise tolerance Fatigue Dry cough Dyspnoea Paroxysmal Nocturnal Dyspnea Orthopnea Palpitations Anorexia Abdominal Bloating

10. Signs : S3 and S4 Sounds are heard Tachycardia Edema Pulmonary crackles Weak peripheral pulse Pallor Hepatomegaly Jugular venous distension

11. Diagnostic studies : History collection Physical examination Chest X – Ray Electro cardiogram Echocardiography Cardiac catheterization

12. Management : Medical : Nitrates : I sosorbitrate Loop diuretics : Furosemide ACE Inhibitors : Captopril Beta Adrenergic blockers : Atenolol Aldosterone agonists : Spironolactone Cardiac glycoside : Digoxin Anticoagulants : Warfarin Surgical : For terminal end stage patients - Cardiac transplantation

13. HYPERTROPHIC CMP it is an autosomal dominant condition. It is asymmetric myocardial hypertrophy without ventricular dilation. When the septum between two ventricles becomes enlarged which reduces ventricular size and obstructs the blood flow from left ventricle and it is known as hypertrophic obstructive cardiomyopathy.

14. Etiology : Aortic stenosis Hypertension Genetic or family history It is more common in men than women and it is the most common cause of sudden death among health young people.

15. Pathophysiology Due to etiological factors Thickened intra-ventricular septum & ventricular wall Ventricular hypertrophy Ventricular dysfunction Impaired ventricular filling & decreased outflow Decreased cardiac output Clinical features

16. Clinical Features : Exertional dyspnea (shortness of breath during exercise) - due to elevated left ventricular diastolic pressure. Fatigue - because of decrease in cardiac output. Angina – increased left ventricular muscle mass. Syncope – increase in obstruction to aortic outflow. Hypertension Arrhythmias

17. Diagnostic studies : History collection Physical examination 12 lead ECG : increased duration of QRS Complex. Echocardiography Doppler imaging Cardiovascular MRI Cardiac Catheterization

18. Management : Medical : Beta Adrenergic blockers – Atenolol Calcium channel blockers – Verapamil Antidysrythmic drugs – Amiodarone In case of A rrythmias , alternate treatment may be Implantable defibrillator. It is a small instrument placed in the chest as a pacemaker. It reduces outflow obstruction.

19. Surgical : Indication for surgery include severe symptoms refractory to medications & obstruction to Aortic outflow. Ventriculomyotomy & Myectomy It involves incision of the hypertrophied septal muscle and resection of some of the hypertrophied muscle. Alcohol S eptal Ablation It is a new procedure performed in the catheterization laboratory. It consists of administering absolute alcohol into the first septal artery (Left Anterior Descending Artery).

20. Restrictive CMP It is characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. Systolic functions remain unaffected. It is the least common type.

21. Etiology : Idiopathic Pathologic processes involved are : Myocardial Fibrosis, Hypertrophy, Infiltration Secondary causes : Amyloidosis (amyloid – a protein substance, is deposited within the cells), Endocardial Fibrosis. Post radiation therapy Sarcoidosis (growth of tiny collections of inflammatory cells) Ventricular Thrombus

22. Pathophysiology : Due to etiological factors Stiffness of the ventricular wall with loss of ventricular compliance Ventricles become resistant to filling Decrease cardiac output

23. Clinical Features : Angina Syncope Fatigue Dyspnea on exertion Exercise Intolerance Tachycardia Peripheral edema & Ascites Palpitations Kussmaul’s Sign (bulging of the internal jugular neck veins on inspiration)

24. Diagnostic Studies : History Collection & Physical Examination Chest X – Ray ECG – shows sign of arrhythmias Echocardiography – thickened ventricular wall CT Scan Endomyocardial Biopsy Nuclear Imaging

25. Management : Medical : Beta Adrenergic Blockers : Atenolol Calcium Channel Blockers : Verapamil Steroids : Hydrocortisone Antidysrhythmic Drugs : Amiodarone Surgical : Cardiac Transplantation Artificial heart implantation (made up of Titanium & patented polyurethane)

26. Arrhythmogenic Right Ventricular Cardiomyopathy : It is an uncommon form of inherited heart muscle disease. It occurs when myocardium is progressively infiltrated & replaced by fibrous scar and adipose tissue. As the disease progress, entire heart is affected. Right ventricle dilates and develops poor contractility. Palpitations, Syncope & Ventricular tachycardia are the symptoms commonly seen. 12 Lead ECG, Holter Monitor, Echocardiography, Cardiac MRI are done to rule out the disease.

27. Unclassified CMP : It is a different form, have characteristics of more than one of previous types. It is caused due to Fibroelastosis , Noncompacted Myocardium, systolic dysfunction and mitochondrial disease. Unclassified CMP include Left Ventricular Noncompaction & stress induced CMP.

28. Nursing Management : Decreased Cardiac Output related to ventricular dysfunction. Impaired Tissue perfusion related to insufficient blood supply. Impaired breathing pattern related to decreased thoracic excursion. Activity intolerance related to shortness of breath. Imbalanced nutrition, less than body requirement related to restricted diet. Fatigue related to cardiac dysfunction.

29. THANK YOU