Cardiomyopathies (Dilated, Hypertrophic, Restrictive) for Progressive Care Certified Nurse (PCCN)

Cardiomyopathies (Dilated, Hypertrophic, Restrictive)

Definition/Etiology:

• Definition
  • Diseases that affected the Myocardium (middle layer/pumping muscle)
• Types & Etiology/Cause
  • Dilated
    • Most Common/90% Cases
    • Idiopathic
    • Myocarditis
    • Pregnancy
    • Drug/ETOH abuse
    • Chagas Disease = Travel to Africa
  • Hypertrophy
    • Inherited (60-70%)
    • Hypertension
    • Common in Athletes (SCD)

Pathophysiology:

• Gas Station Analogy = PUMP FAILURE
• Dilated Cardiomyopathy
  • Ventricular walls thin
  • Ventricles Dilated/Weak
  • Muscle construction weak
  • Cannot squeeze = Systolic Dysfunction
• Hypertrophic Cardiomyopathy
  • Ventricular Walls VERY thick
  • Ventricles Rigid/Stiff
  • Muscle cannot Relax
  • Cannot FIll = Diastolic Dysfunction

Noticing: Assessment & Recognizing Cues:

• Subjective
  • Chest Pain
  • Tired/Fatigues
  • SOB/Dyspnea
  • Swelling of feet
• Objective
  • Heart Sounds
    • Dilated = S3 “Sloshing-In”
    • Hypertrophic = S4 “A-Stiff-Wall”
    • Murmurs – Mitral/Aortic
  • Lung Sounds
    • Lungs = WET

Interpreting: Analyzing & Planning:

• Labs
  • ABGs – Hypoxemia
  • Electrolytes – Decreased KCL/MAG
  • Troponin – Infarcts
  • BUN/Creatinine – Rebel Function
• Diagnostics
  • ECG
    • Arrhythmias
    • Atrial, Ventricular or AV Blocks (Lesson included)
  • Echocardiogram
    • Wall Thickness
    • Ventricle dimensions
    • Ejection Fraction
  • CXR
    • Cardiomegaly
    • Pulm Congestion

Responding: Patient Interventions & Taking Action:

• Pharmacological Interventions
  • 02 Support
  • Beta-Blockers – increase Cardiac Output
  • Ace-Inhibitors – Decrease Afterload
  • Diuretics – Get Fluid OUT
  • Digoxin – Better Contraction
• Non-Pharmacological Interventions
  • Ambulate AS TOLERATED
  • Sodium Restriction
  • Implanted Placemakers/DEFIB
  • Valve Replacement
  • Transplant
• Adjunct Medical Therapy
  • Cardiology – Plumbing
  • Electrophysiologist_Electricity

Reflecting: Evaluating Patient Outcomes:

• DR – Identify underlying cause (Treat/remove)
  • Nothing we do will help if not identified!
• HF Symptoms Relieved
• Prevent MIs & Sudden Cardiac Death
• Pain Management

Linchpins (Key Points):

• Notice
  • Objective/Subjective Cues HF
• Interpret
  • ECHOCARDIOGRAM
    • Walls, Ventricles, Valves & Output
• Respond
  • Treating underlying cause
  • Pharm, Non-Pharm
  • Cardiology & Electrophysiologist
• Reflect
  • Symptomatic? Reduce MIs/SCD