Cardiomyopathy and Congestive Heart Failure

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Cardiomyopathy and Congestive Heart Failure

• NPN 200
• Medical Surgical I

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Cardiomyopathy

• Disease of the heart muscle
• Cause is unknown
• Occurs in only 10-20 per 100,000
• Results in 30,000 deaths/year
• 3 types
• Dilated both ventricles
• Hypertrophic usually die by age 40
• Restrictive rarest

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Cardiomyopathy

• Characterized by left and right ventricular
  failure
• Some may be asymptomatic for years and others
  have acute onset
• Stroke volume and cardiac output are decreased
• Atypical chest pain which occurs at rest
• Progressive and chronic disease

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Cardiomyopathy, cont.

• Signs and symptoms are dependent upon the type
• Dilated
• Dyspnea
• Fatigue
• Left sided heart failure
• Cardiomyopathy
• Mitral regurgitation (S1 and S2 sounds heard)
• Hypertropic
• Syncope
• Ankle edema
• Orthopnea
• Angina
• Restrictive
• Exercise intolerance
• Dyspnea
• Fatigue
• Right sided heart failure
• S3 and S4

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Cardiomyopathy, cont.

• Diagnosis
• Echo - primary
• Angiography
• Radionuclide imaging
• Dysrhythmias
• Decreased CO with restrictive

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Cardiomyopathy, cont

• Interventions
• Drugs
• Diuretics, vasodilators, cardiac glycosides, beta
  blockers, anticoagulants
• Surgery
• Excision of the hypertrophied muscle
• Mitral valve replacement
• Cardiomyoplasty chest muscle wrapped around the
  heart
• Heart transplant

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Nursing Care

• Assess
• Dyspnea
• Cough
• Edema
• Dysrhythmias
• Decreased CO
• Need lots of family support and teaching about
  the disease

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Heart Transplant

• Transplanted form a donor with comparable weight
  and ABO compatibility into a recipient less than
  6 hours after procurement
• Donor must be free of infection, no chest trauma
  and be declared brain dead, and no malignancies
• Most of the cases of transplant are to patients
  with cardiomyopathy
• Patients with a history of noncompliance,
  depression or inability to cope with stress are
  not considered good candidates

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Heart Transplant, cont.

• Recipient is prepared for Open Heart Surgery and
  placed on cardiopulmonary bypass and the anterior
  portions of the patients heart are removed and
  replaced with the donor heart
• Post op care is similar to CABG patients
• Must be protected from infection by isolation
• Must receive immunosuppressant drugs for life, as
  well as steroids (Solu-Medrol, CellCept, Prograf,
  Imuran, Sandimmune)
• Watch for rejection temp, malaise, fatigue,
  dysrhythmias
• Monitored by endocardial biopsies
• Complications include
• Hypertension, cholesterol, obesity, and
  malignancies

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Congestive Heart Failure/Left Sided Heart Failure

• Causes the most hospitalizations in patients over
  the age of 65
• 5 million people on the US are living with heart
  failure
• Inadequacy of the heart to pump blood throughout
  the body effectively
• This deficit causes insufficient perfusion of
  body tissues with nutrients and oxygen
• Causes of heart failure
• Coronary artery disease
• Acute MI
• Cardiomyopathy
• Hypertension
• COPD
• Anemia
• Fluid volume overload
• Disease of the heart valves

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CHF, cont.

• 2 ventricles pump independently
• Can have right or left sided failure
• Usually the left side fails 1st and progresses to
  failure of both ventricles
• May be acute or chronic
• May be mild or severe
• May be systolic or diastolic failure
• May cause pulmonary edema or enlarged liver
• Causes retention of sodium and water by the
  kidneys

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CHF, cont.

• Right sided failure
• May be caused by left ventricle failure, RV
  infarct, or Pulmonary hypertension
• Right ventricle is unable to empty completely
• Increased volume and pressure develops in the
  systemic veins and systemic vascular congestion
  develops with peripheral edema
• Patient may gain fluid weight and have
  nausea/anorexia, ascites may develop
• High output failure
• Caused by increased metabolic needs
• Septicemia, anemia, and hyperthyroidism

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CHF, cont.

• Compensation how the body responds to maintain
  adequate cardiac output
• Sympathetic
• Renal
• Ventricular hypertrophy

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CHF, cont.

• Diagnostic tests
• History and physical
• Chest x-ray shows cardiomegaly with hazy lung
  fields
• Echocardiogram will show enlarged heart and poor
  contraction of ventricles
• BUN and creatinine
• Na and Hct may be decreased due to dilution
• SAO2 may be decreased
• LFTs may be elevated
• B-type Natriuretic peptide (BNP) produced and
  released by the ventricles increases

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CHF, cont.

• Objective symptoms
• Left sided failure
• Anxious
• Pale
• Tachycardia
• Dyspnea, with crackles, wheezes
• Orthopnea
• Non-productive cough
• Later productive cough with frothy, bloody sputum
• Oliguria

• Objective symptoms
• Right sided failure
• Weight gain
• Pitting, dependent edema
• JVD
• Ascites
• Decreased UOP
• Distended neck veins
• N/V, anorexia

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Nursing Assessment

• Vital signs with both apical and radial pulse
• HOB elevated
• Peripheral pulses
• JVD
• CVP
• Orientation with GCS
• Assess for crackles and wheezes
• Dependent edema
• Weight
• Accurate I/O
• Abdominal girth
• Assess for client and family emotional status

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CHF, cont.

• Medical treatment
• Treat the cause hypertension, rhythm problems,
  valve repair
• Drugs cardiac glycosides, diuretics, inotropic
  agents, vasodilators, ACE inhibitors, beta
  blockers, Natrecor
• Diet restrictions of sodium and increase of K
  if diuresis is occuring
• Restriciton of H2O
• Surgery
• Cardiomyoplasty
• Heart transplant
• Heart reduction surgery

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Nursing Interventions

• Client education for home care
• Must adjust lifestyle
• May need O2
• S/S to report to provider
• Weight control contact physician if more than 2
  lb weight gain in a week
• Dietary management
• Medication review
• Exercise regimen
• Need to work with client to balance activity and
  rest periods
• Monitor for complications
• Many have outpatient CHF clinics