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Cardiomyopathy

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on 31 May 2014

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Transcript of Cardiomyopathy

62
ECG
bpm
Thank You!
Cardiomyopathy
Disease of the cardiac muscle
Can be subacute or chronic
Primary cardiomyopathy: when the cause is not known
Secondary cardiomyopathy: results from a disease process
Types of Cardiomyopathy
Dilated
Hypertrophic
Restrictive
Arrhythmogenic Right Ventricular

Dilated Cardiomyopathy
DCM is a structural abnormality
Most common; twice as common among men as women
Diagnosis is most common in middle age
Extenisive damage to the myofibrils
Interferes with myocardial metabolism
Ventricular wall thickness is
normal
Both ventricles are dilated
Impaired systolic function
Hypertrophic Cardiomyopathy
-Enlargement of a portion of the myocardium; most commonly the left ventricle and the ventricular septum.
-Less room for ventricular filling = Decreased CO
-Enlargement of the intraventricular septum can obstruct of the aortic valve


Types of Cardiomyopathy:
Ashley Gushulak
Dana Stampfli
Heather Spencer
Kyle Baden
Leilla Jakob

Cardiomyopathy
http://www.nature.com/nrcardio/journal/v10/n9/full/nrcardio.2013.105.html
Alcohol abuse
Chemotherapy
Infection
Inflammation
Poor Nutrition

Higher mortality rates are associated with
increased age
Male sex
Severe CHF

Prognosis
50% of patients with CHF die within 5 years
Etiology &
Risk Factors
https://www.genedx.com/test-catalog/cardiology/dilated-cardiomyopathy/
Signs and Symptoms
Differentiating symptoms:
Paroxysmal nocturnal dyspnea
Dry cough at night
Narrow pulse pressure
S3 gallop rhythm
Pansystolic murmur

On Assessmnet:
Signs of HF
Fluid volume overload
Tachypnea
Tachycardia
Hypertension
Signs and Symptoms
Differentiating syptoms
-Syncope

-Sudden death (especially in athletes)

-Migratory joint pain

-Abdominal pain
Restrictive Cardiomyopathy
Most rare subclass of cardiomyopathy
Associated with lack of flexibility of the ventricular walls.
Ventricles that restrict filling during diastole due to the physical inability to relax.
Poor prognosis, many patients die 1-2 years after diagnosis


Etiology
Diseases in which the heart is intruded by foreign material or scarred.
• Collection of unwanted proteins (amyloidosis)
• Iron overload (hemochromatosis)
• Abnormal collection of inflammation growth tissue (sarcoidosis)




Most patients are asymptomatic until adulthood
Differentiating symptoms:
• Heart block
• Embolus




Hallmark symptoms:
Signs of right-sided CHF

Etiology and Risk factors
-The etiology is usually associated with genetic mutations
-Other causes are still unknown!

-The only real known risk factor is a genetic link.

-Children with a parent who has the condition are 50% more likely to inherit it.

-If a link exists, early testing is crutial
backfixer1.blogspot.com/2010/05/personal-gene-tests-good-or-bad-idea.html
www.barnesjewish.org/heart-vascular/hypertrophic-cardiomyopathy
www.lond.ambulance.freeuk.com/ecg/ECG2.htm
www.jeevanti.co.in/blog/-/blogs/stay-younger-longer
Complications:
-Arrhythmia (a-fib, v-tach, and v-fib)
-Obstructed blood flow
-Mitral valve regurgitation
-Heart failure
-Sudden death
Treatments:
-Medication: Beta-blockers, CCB, antiarrhythmics

-Septal myectomy

-Alcohol septal ablation

-Implantable cardioverter-defibrillator
www.hrsonline.org/patient-resources/treatment/implantable-cardioverter-defibrillator#axzz32lhax6al
References:
Cardiomyopathy.
(n.d.). Retreived from http://www.nature.com/nrcardio/journal/v10/n9/full/
nrcardio.2013.105.html
Dilated cardiomyopathy.
(n.d.). Retrieved from https://www.genedx.com/test-catalog/cardiology/dilated-
cardiomyopathy/
DNA.
(n.d.). Retrieved from http://backfixer1.blogspot.com/2010/05personal-gene-tests-good-or-bad-
idea.html
Echocardiogram.
(n.d.). Retrieved from http://www.learningradiology.com/lectures/cardiaclectures/Heart
%20Inside%20and%20Out-2012/Heart%20InsidIe%20and%20Out-2012.html
Harsh, P., & Hugh, C. (2010). Arrhythmogenic right ventricular dysplasia. Current Treatment Options in
Cardiovascular Medicine, 12(6), 598-613.
Hypertrophic cardiomyopathy.
(n.d.). Retrieved from http://www.barnesjewish.org/heart-vascular/
hypertrophic-cardiomyopathy
Implanted cardioverter-defibrillator
. (n.d.). Retrieved from http://www.hrsonline.org/Patient-Resources/
Treatment/Implantable-Cardioverter-Defibrillator#axzz32lhAx6AL
Ignatavicius, D., & Workman, M. L. (2013).
Medical-surgical nursing: Patient-centered collaborative care
(7th ed.)
. St. Louis, MO: Saunders Elsevier.
Left bundle branch block.
(n.d.). Retrienved from http://www.lond.ambulance.freeuk.com/ecg/ECG2.htm
Man with shortness of breath.
(n.d.). Retrieved from http://www.jeevanti.co.in/blog/-/blogs/stay-younger-
longer
Mayo clinic staff. (2014, Feb 22).
Hypertrophic cardiomyopathy
. Retrieved from http:/www.mayoclinic.org/
diseases-conditions/hypertrophic-cardiomyopathy/basics/treatment/con-20030747
Wagner, K.D., Hardin-Pierce, M.G. (2014).
High-Acuitity Nursing (6th ed.)
. Upper Saddle River, N.J.: Pearson Education Inc.
Nursing central. (2013, October 8). cardiomyopathy. Retrieved from ____http:nursing.unboundmedicine.comnursingcentral/ub/view/Diseases-and-Disorders/73547/all/Cardiomyopathy?q=cardiomyopathy

Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C)
An inherited cardiomyopathy characterized by structural and functional abnormalities in the right ventricle (RV)
Important cause of sudden cardiac death (SCD) in young adults
Included in the World Health Organization’s classification of cardiomyopathies in 1996
More common in individuals of Greek and Italian origin
Etiology
ARVD/C is an inherited disorder
Most common pattern of inheritance is autosomal dominance
Some evidence shows that ARVD/C may result from an infection within the heart muscle
Often caused by mutations in the desmosomes
Mechanical bonds that hold heart cells together are defective
Over time, the heart cells may pull apart, starting a process of scar and fat replacement

Signs and Symptoms
Arrhythmias
Syncope
Sudden cardiac arrest

Diagnosis
No single test that can either establish or exclude ARVD/C

Physical exam, family history, various cardiac tests, and genetic information are used as criteria


CASE STUDY
A 58 yr. old male with a history of HTN, CAD, and 2 yrs post MI presents to the ED with increasing fatigue, waking in the night with SOB, & inability to perform normal daily activities. He is a non-smoker, but drinks a 6-pack of beer nightly and currently takes lovastatin, and enalapril daily.
Assessments
Vitals(BP,HR,Spo2)
Tele. (continuous)
Heart & Lung sounds
Fluid status (edema, cap refill, JVD)
UOP
Weight
WHY?

Labs/Diagnostics
CMP/CBC
ANP/BNP
Lipid panel
Chest X-ray
2-D echocardiogram w/doppler flow studies
Cardiac catheterization
Treatments
Beta-blockers
ACE inhibitors
ARB's
Diuretics
Inotropic drugs (dobutamine)
ICD (implantable cardioverter/defibrillator)
CRT (cardiac resynchronization therapy)
Mitral valve replacement
Coronary artery bypass
Heart transplant
Patient Teaching
Medication management
Monitor weight
Proper sleeping habits
Monitor activity levels
Orthostatic hypotension
Electrolyte replacement
Dietary restrictions
Reducing risk factors
http://learning radiology.com/lectures/cardiaclectures/heart%20inside%20and%20out-2012/heart%20inside%20and%20out-2012.html
Symptoms common to all types:
Shortness of breath
Orthopnea
Exertional dyspnea
Fatigue
Palpitations
Edema
Chest pain
Arrhythmias
Signs and symptoms
Complications
http://www.webmd.com/dvt/venous-thrombus-and-embolus
http://www.medindia.net/symptoms/fainting.htm
http://www.oocities.org/suez_canal_hospital/about_cardiomyopathy.html
Treatments
Medications:
Reduce preload
Reduce afterload
Diuresis
Airway support

Surgical Options:
Left Ventricular Assist Devices
Cardiac Resynchronization (Biventricular pacing)
Automatic Implantable Cardioverter- Defibrillators
Ventricular Restoration Surgery
Heart Transplantation
Treatments
Beta-blockers aid with bradycardia to allow ventricles to fill
ARBs
ACE inhibitors
calcium channel blockers
Aldosterone Antagonists
Cardiac Glycosides
Diruetics
Vasodilators
http://www.nhlbi.nih.gov/health/health-topics/topics/ht/printall-index.html
Ventricular & Supraventricular arrhythmias
Conduction system abnormalities
Thromboembolism
Death
Diagnostic Tests
CBC
Metabolic Panel
BNP
Genetic testing
Cardiac catheterization
Chest X-Ray
Echocardiography
MRI
ECG
Cardiac stress test
Echocardiogram
Treatments
Medications: Beta blockers and ACE-inhibitors
Implantable cardioverter defibrillators
Catheter ablation
Full transcript