Cardiomyopathy

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.

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

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

18. Cardiomyopathy Nursing Management • Activity intolerance related to low cardiac output.

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

20. Thank You