Cardiomyopathy refers to disease of the heart muscle or electrical dysfunction. the Causes of cardiomyopathy are classified as PRIMARY or SECONDARY

1. CRDIOMYOPATHY

2. CARDIOMYOPATHY
 Cardiomyopathy refers to disease of the heart
muscle or electrical dysfunction.

3. CARDIOMYOPATHY

4. CAUSES
Causes of cardiomyopathy are classified as
PRIMARY or SECONDARY
1. Primary cardiomyopathies have genetic, mixed, or
acquired etiologies.
2. Secondary cardiomyopathies have infiltrative, toxic
or inflammatory causes

5. Types of cardiomyopathies
 Cardiomyopathies classified according to the structural
abnormalities of the heart muscle.
1. Dilated cardiomyopathy (DCM)
2. Hypertrophic cardiomyopathy (HCM)
3. Restrictive or Constrictive cardiomyopathy (RCM)
4. Arrhythmogenic right ventricular cardiomyopathy
(ARVC) and unclassified cardiomyopathy

6. Etiopathophysiology
 Dilated cardiomyopathy (DCM) : Dilated cardiomyopathy is
the most common form of cardiomyopathy. It can be
divided into two types ischemic and non ischemic
cardiomyopathy.
1. ischemic cardiomyopathy :
a) It is caused by inadequate oxygen supply due to
obstruction in coronary artery.
b) The lack of oxygen interrupts both mechanical &electrical
function of the cells , decrease contractility , and causes
dysrhythmias.

7. 2) Non ischemic cardiomyopathy:
a) Cause id idiopathic ( unknown)
b) 10 to 50 % of cases are identified by genetic mutation
c) Both the RV & LV enlarge significantly, causing a
decrease in the ability of the heart to pump blood
efficiently to the body.

8. Dilated cardiomyopathy (DCM)
 Alcohol abuse
 Chemotherapy
 Chemical agents
 Myocarditis
 Pregnancy ( third trimester & postpartum)
 Valve disease, endocrine disorders, and infections
such as HIV can cause dilated cardiomyopathy.

9. Hypertrophic cardiomyopathy (HCM)
 Hypertrophic cardiomyopathy is a genetically
transmitted disorders.
 Hypertrophic cardiomyopathy is primarily due to the
abnormal thickening of the ventricular septum of the
heart.
 The thickened heart muscle & ultrastructure disruption
change the shape, size, & dispensability of the
ventricular cavity & alter the normal thickens &
functioning of the mitral valve; as a result, the heart
ability to relax & contract normally is impaired.

10. Restrictive or Constrictive cardiomyopathy
(RCM)
 The heart muscle becomes infiltrated by various
substances , resulting in severe fibrosis.
 The heart muscle becomes stiff and non distensible,
impairing the ability of the ventricle to fill with blood
adequately.

11. Arrhythmogenic right ventricular
cardiomyopathy
 Autosomal genetic disorder affects 1 in 2,000 to 5,000
more common among men
 Arrhythmogenic right ventricular cardiomyopathy
characterized by placement of the RV myocytes by
fibro-fatty tissue, RV dysfunction, & ventricular
dysrhythmias.

12. Complications of cardiomyopathy
 CHF
 Ventricular dysrhythmias
 Atrial dysrhythmias
 Cardiac conduction defects
 Pulmonary or cerebral embolism
 Valvular dysfunction
 Pulmonary embolism
 Sudden cardiac death

13. Clinical manifestations
 Patients with cardiomyopathy may remain stable and
without symptoms for many years, As the disease
progress, so do symptoms.

14. Clinical manifestations
 Frequently Dilated cardiomyopathy or Restrictive
cardiomyopathy is first diagnosed when the patient
presents with sings and symptoms of heart failure (
dyspnea on exertion, fatigue)
 Patients with cardiomyopathy may also report PND,
Cough, and orthopnea, which may lead to misdiagnosis of
bronchitis or pneumonia.
 Other symptoms include fluid retention, Peripheral edema,
and nausea
 The patient also may experience chest pain, palpitations,
dizziness, and syncope

15. other common clinical manifestations
 Exertional dyspnea
 Chest pain
 Signs of HF
 Pulmonary edema
 Dysarhythmias
 Pericardial effusions
 Cardiac murmur
 Sudden cardiac death may be the first sign with
Arrhythmogenic right ventricular cardiomyopathy

16. Assessment and diagnostic
Evaluation
 History collection(History of the disease in immediate family
members)
 Cardiovascular examination
 Chest X-ray ( for cardiomegaly)
 ECG (may show dysrhythmias)
 Echocardiogram (The echocardiogram is one of the most
helpful diagnostic tools because the structure and function
of the ventricles can be observed easily.)
 Cardiac catheterization ( to help diagnose ischemic or
non- ischemic)

17. Management client with cardiomyopathy
 The goal of management is to maximize ventricular
function and prevent complications associate with
cardiomyopathy.

18. Management client with cardiomyopathy
 Medical management is directed toward determining
and managing possible underlying causes, correcting
the heart failure with medications, a low – Sodium diet,
and an exercise /rest regimen and controlling
dysrhythmias with anti arrhythmic medications and
possibly with an implanted electronic devices, such as
an implanted cardioverter defibrillator (ICD) .

19. Management client with cardiomyopathy
 Infective endocarditis prophylaxis and systematic
anticoagulation to prevent thromboembolic events are
usually recommend.
 The person with HCM may also have to limit physical
activity to avoid a life-threatening dysrhythmia. A
pacemaker may be implanted to alter the electrical
stimulation of the muscle and prevent the forceful
hyperdynamic contractions that occur with HCM

20. Surgical Management client with
cardiomyopathy
 When heart failure progresses and medical treatment
is no longer effective, surgical intervention, including
heart transplantation, is considered. However, because
of the limited number of organ donors, many patients
die waiting for transplantation.
In some cases, a Left ventricular assist device (LVAD)
is implanted to support the failing heart until a suitable
donor heart becomes available.

21. Left ventricular assist device (LVAD)
 A left ventricular assist device, or LVAD, is a
mechanical pump that is implanted inside a person's
chest to help a weakened heart pump blood.

22. Left ventricular assist device (LVAD)

23. Left ventricular assistive device ( LVAD)

24. Left Ventricular Outflow Tract Surgery.
 The most common procedure is a Myectomy
(sometimes referred to as a Myotomymyectomy), in
which some of the heart tissue is excised. Septal tissue
approximately 1 cm wide and deep is cut from the
enlarged septum below the aortic valve.
 The length of septum removed depends on the degree
of obstruction caused by the hypertrophied muscle.

25. Left Ventricular Outflow Tract Surgery.
 The primary complication of both procedures is
dysrhythmia; additional complications are postoperative
surgical complications such as:
 Pain
 Ineffective airway clearance
 Deep vein thrombosis (DVT)
 Risk for infection and delayed surgical recovery.

26. Heart Transplantation.
 The first human-to-human heart transplant was
performed in 1967. Since then, transplant procedures,
equipment, and medications have continued to
improve.
 heart transplantation has become a therapeutic option
for patients with end-stage heart disease.

27. Heart Transplantation Techniques.
 Orthotopic transplantation : is the most common
surgical procedure for cardiac transplantation.
The recipient’s heart is removed, and the donor heart is
implanted at the vena cava and pulmonary veins.

28. Heart Transplantation Techniques.
 Heterotopic transplantation: is less commonly
performed .The donor heart is placed to the right and
slightly anterior to the recipient’s heart; the recipient’s
heart is not removed.

29. Postoperative Course
 Heart transplant patients are constantly balancing the
risk of rejection with the risk of infection. They must
comply with a complex regimen of diet, medications,
activity, follow-up laboratory studies, biopsies (to
diagnose rejection), and clinic visits. Most commonly,
patients receive cyclosporine or tacrolimus (FK506,
Prograf), azathioprine (Imuran) or
mycophenolatemofetil (CellCept), and corticosteroids
(ie, prednisone) to minimize rejection.

30. Mechanical Assist Devices and Total
Artificial Hearts
 Ventricular Assist Devices ( VAD) . More complex
devices that actually perform some or all of the
pumping function for the heart also are being used.
 Total Artificial Hearts. Total artificial hearts are
designed to replace both ventricles. Some require the
removal of the patient’s heart to implant the total
artificial heart; others do not.

31. Nursing management:
patient with cardiomyopathy
 Nursing assessment for the patient with
cardiomyopathy begins with a detailed history
of the presenting signs and symptoms. The
nurse identifies possible etiologic factors, such
as heavy alcohol intake, recent illness or
pregnancy, or history of the disease in
immediate family members

32. Nursing management:
patient with cardiomyopathy
 Evaluate clients chief complaint, which may include chest
pain, fever, syncope, general aches, fatigue, dyspnea.
 Evaluate etiologic factors , such as alcohol abuse,
pregnancy, recent infection, or history of endocrine
disorders.
 Assess for positive family history
 Auscultate lung sounds for crackles ( pulmonary edema)
or decreased sound (Pleural effusion)
 Evaluate cardiac rhythm & ECG for evidence of atrial or
ventricular enlargement or infection.

33. Nursing management:
patient with cardiomyopathy
The physical assessment focuses on signs and symptoms of
congestive heart failure. The baseline assessment includes
such key components as:
 Vital signs
 Calculation of pulse pressure and identification of pulsus
 paradoxus
 Current weight; determination of weight gain or loss
 Detection by palpation of the point of maximal impulse,
often shifted to the left

34. Nursing management:
patient with cardiomyopathy
 Cardiac auscultation for a systolic murmur and third
and fourth heart sounds
 Pulmonary auscultation for crackles
 Measurement of jugular vein distention
 Identification of presence and severity of edema

35. NURSING DIAGNOSES
 Decreased cardiac output related to decreased
ventricular function and /or dysrhythmias.
 Ineffective cardiopulmonary, cerebral, peripheral, and
renal tissue perfusion related to decreased peripheral
blood flow (resulting from decreased cardiac output).
 Impaired gas exchange related to pulmonary
congestion caused by myocardial failure (decreased
cardiac output).
 Activity intolerance related to decreased cardiac output
or excessive fluid volume, or both.

36. NURSING DIAGNOSES
 Anxiety related to fear of death, surgical procedures,
and hospitalization.
 Noncompliance with medication and diet therapies

37. Nursing interventions
 Improving cardiac output
 Increasing activity tolerance
 Reducing anxiety

38. Patient education and health maintenance
 Teaching Patients Self-Care :Teaching patients
about the medication regimen, symptom monitoring,
and symptom management is a key part of the plan of
nursing care.