Cardiomyopathy and congestive heart failure
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Cardiomyopathy and Congestive Heart Failure. NPN 200 Medical Surgical I. 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

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Cardiomyopathy
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


Cardiomyopathy1
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


Cardiomyopathy cont
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


Cardiomyopathy cont1
Cardiomyopathy, cont.

  • Diagnosis

    • Echo - primary

    • Angiography

    • Radionuclide imaging

    • Dysrhythmias

    • Decreased CO with restrictive


Cardiomyopathy cont2
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


Nursing care
Nursing Care

  • Assess

    • Dyspnea

    • Cough

    • Edema

    • Dysrhythmias

    • Decreased CO

    • Need lots of family support and teaching about the disease


Heart transplant
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


Heart transplant cont
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


Congestive heart failure left sided heart failure
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


Chf cont
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


Chf cont1
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


Chf cont2
CHF, cont.

  • Compensation – how the body responds to maintain adequate cardiac output

    • Sympathetic

    • Renal

    • Ventricular hypertrophy


Chf cont3
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

    • LFT’s may be elevated

    • B-type Natriuretic peptide (BNP) – produced and released by the ventricles increases


Chf cont4

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

CHF, cont.


Nursing assessment
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


Chf cont5
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


Nursing interventions
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


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