cardiomyopathy and congestive heart failure

7/28/2019 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 muscleCause is unknown

Occurs in only 10-20 per 100,000Results in 30,000 deaths/year 3 types

Dilated both ventriclesHypertrophic usually die by age 40Restrictive rarest


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Cardiomyopathy

Characterized by left and right ventricular failureSome may be asymptomatic for years andothers have acute onsetStroke volume and cardiac output aredecreasedAtypical chest pain which occurs at restProgressive and chronic disease


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Cardiomyopathy, cont.Signs and symptoms are dependent upon the type

DilatedDyspneaFatigueLeft sided heart failureCardiomyopathyMitral regurgitation (S1 and S2 sounds heard)

HypertropicSyncopeAnkle edemaOrthopneaAngina

RestrictiveExercise intoleranceDyspneaFatigueRight sided heart failureS3 and S4


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Cardiomyopathy, cont.

DiagnosisEcho - primaryAngiographyRadionuclide imagingDysrhythmiasDecreased CO with restrictive


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Cardiomyopathy, cont

InterventionsDrugs

Diuretics, vasodilators, cardiac glycosides, beta blockers, anticoagulants

SurgeryExcision of the hypertrophied muscle

Mitral valve replacementCardiomyoplasty chest muscle wrapped around theheartHeart transplant


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Nursing Care

AssessDyspneaCoughEdemaDysrhythmiasDecreased CO

Need lots of family support and teaching about thedisease


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Heart Transplant

Transplanted form a donor with comparable weightand ABO compatibility into a recipient less than 6hours after procurement

Donor must be free of infection, no chest trauma and be declared brain dead, and no malignanciesMost of the cases of transplant are to patients withcardiomyopathy

Patients with a history of noncompliance, depressionor inability to cope with stress are not consideredgood candidates


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Heart Transplant, cont.

Recipient is prepared for Open Heart Surgery and placed oncardiopulmonary bypass and the anterior portions of the

patients heart are removed and replaced with the donor heartPost op care is similar to CABG patients

Must be protected from infection by isolationMust receive immunosuppressant drugs for life, as well assteroids (Solu-Medrol, CellCept, Prograf, Imuran,Sandimmune)

Watch for rejection temp, malaise, fatigue, dysrhythmiasMonitored by endocardial biopsiesComplications include

Hypertension, cholesterol, obesity, and malignancies


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Congestive Heart Failure/Left SidedHeart Failure

Causes the most hospitalizations in patients over the age of 655 million people on the US are living with heart failureInadequacy of the heart to pump blood throughout the body effectivelyThis deficit causes insufficient perfusion of body tissues with nutrients andoxygen

Causes of heart failureCoronary artery diseaseAcute MICardiomyopathyHypertensionCOPDAnemiaFluid volume overloadDisease of the heart valves


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CHF, cont.

2 ventricles pump independentlyCan have right or left sided failureUsually the left side fails 1 st and progresses to failure

of both ventriclesMay be acute or chronicMay be mild or severeMay be systolic or diastolic failureMay cause pulmonary edema or enlarged liver Causes retention of sodium and water by the kidneys


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CHF, cont.

Right sided failureMay be caused by left ventricle failure, RV infarct, or Pulmonary hypertensionRight ventricle is unable to empty completely

Increased volume and pressure develops in the systemicveins and systemic vascular congestion develops with peripheral edemaPatient may gain fluid weight and have nausea/anorexia,ascites may develop

High output failureCaused by increased metabolic needsSepticemia, anemia, and hyperthyroidism


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CHF, cont.

Compensation how the body responds tomaintain adequate cardiac output

SympatheticRenalVentricular hypertrophy


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CHF, cont.

Diagnostic testsHistory and physicalChest x-ray shows cardiomegaly with hazy lung fieldsEchocardiogram will show enlarged heart and poor contraction of ventriclesBUN and creatinine ^

Na and Hct may be decreased due to dilutionSAO2 may be decreasedLFTs may be elevated B-type Natriuretic peptide (BNP) produced and released

by the ventricles increases


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CHF, cont.

Objective symptomsLeft sided failure

AnxiousPaleTachycardiaDyspnea, with crackles,wheezesOrthopnea

Non-productive coughLater productive coughwith frothy, bloodysputumOliguria

Objective symptomsRight sided failure

Weight gainPitting, dependent edemaJVDAscitesDecreased UOPDistended neck veins

N/V, anorexia


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Nursing AssessmentVital signs with both apical and radial pulseHOB elevatedPeripheral pulsesJVD

CVPOrientation with GCSAssess for crackles and wheezesDependent edema

WeightAccurate I/OAbdominal girthAssess for client and family emotional status


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CHF, cont.

Medical treatmentTreat the cause hypertension, rhythm problems, valverepair Drugs cardiac glycosides, diuretics, inotropic agents,vasodilators, ACE inhibitors, beta blockers, Natrecor Diet restrictions of sodium and increase of K if diuresis isoccuringRestriciton of H2O

SurgeryCardiomyoplastyHeart transplantHeart reduction surgery


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Nursing Interventions

Client education for home careMust adjust lifestyleMay need O2S/S to report to provider

Weight control contact physician if more than 2 lb weight gain in aweek Dietary managementMedication reviewExercise regimen

Need to work with client to balance activity and rest periodsMonitor for complicationsMany have outpatient CHF clinics

cardiomyopathy and congestive heart failure

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