Description
Cardiomyopathy is a dysfunction of cardiac muscle that can be associated with coronary artery disease, hypertension, cardiotoxic agents, valvular disorders, and vascular or pulmonary diseases. Cardiomyopathies are classified into three groups by etiology and the abnormal physiology of the left ventricle.
- Dilated or congestive cardiomyopathy (DC) – is characterized by ventricular dilation and impaired systolic contractile fuction. Emboli may occur because of blood stasis in the dilated ventricles. This is the most common type cardiomyopathy.
- Hypertrophic cardiomyopathy (HC) – is characterized by inappropriate myocardial hypertrophy without ventricular dilation. Obstruction to left ventricular outflow may or may not be present.
- Restrictive cardiomyopathy (RC) – is characterized by abnormally rigid ventricles with decreases diastolic compliance. The ventricular cavity is decreased, and clinical manifestations are similar to constrictive pericarditis.
Signs and Symptoms
- Dyspnea
- Fatigue
- Dysrhythmias or conduction disturbances
- Onset may be insidious or exhibited by sudden death.
Physical Examination
Vital signs
- HR: increased, irregular rhythm
- BP: increased or decreased, depending on underlying disease or degree of heart failure
- RR: may be increased
Cardiovascular
- Murmurs
- S3 and/ or S4
- Ectopy
- Jugular vein distention
Pulmonary
- Crackles
- Dry cough
Acute Patient Care Management
Nursing Diagnosis: Decreased cardiac output related to left ventricular dysfunction and dysrhythmias.
Outcome Criteria
- Patient alert and oriented
- Skin warm and dry
- Pulses strong and equal bilaterally
- Capillary refill < 3 sec
- BP 90 to 120 mm Hg
- Pulse pressure 30 to 40 mm Hg
- HR 60 to 100 beats/min
- Absence of life-threatening dysrythmias
- Urine output 30 ml/hr
- CVP 2 to 6 mm Hg
Patient Monitoring
- Obtain Bp hourly or more frequently if the patient’s condition is unstable.
- Monitor hourly urine output to evaluate effects of decreased cardiac output or pharmacologic intervention.
- Analyze ECG rhythm strip at least every 4 hours and note rate.
- Continuously monitor oxygen status with pulse oximetry.
- Monitor patient activities and nursing interventions that may adversely affect oxygenation.
Patient Assessment
- Obtain vital signs every 15 minutes during acute phase.
- Assess the patient for changes in neurological function hourly and as clinically indicated.
- Assess for skin warmth, color, and capillary refill time.
- Assess for chest discomfort because myocardial ischemia may result from poor perfusion.
- Assess heart and lung sounds to evaluate the degree in heart failure.
Diagnostic Assessment
- Review ECG
- Echocardiography
- Cardiac catheterization
Patient Management
- Provide oxygen at 2 to 4 L/min to maintain or improve oxygenation.
- Minimize oxygen demand by maintaining the patient at bed rest.
- Provide liquid diet on acute phase,
- Administer diuretic as prescribed to reduce preload and afterload.
- Monitor serum potassium before and after administration of loop diuretics.
- Prophylactic heparin may be ordered to prevent thromboembolus formation secondary to venous poisoning.
- Institute pressure ulcer prevention strategies secondary to hypoperfusion or vasoconstriction agents.
