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 Restrictive rarest

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.

Signs and symptoms are dependent upon the type

Dilated

Dyspnea Fatigue Left sided heart failure Cardiomyopathy Mitral regurgitation (S1 and S2 sounds heard)
Syncope Ankle edema Orthopnea Angina Exercise intolerance Dyspnea Fatigue Right sided heart failure S3 and S4

Hypertropic

Restrictive

Cardiomyopathy, cont.

Diagnosis

Echo - primary Angiography Radionuclide imaging Dysrhythmias Decreased CO with restrictive

Cardiomyopathy, cont

Interventions

Drugs

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

Surgery

Nursing Care

Assess

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

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.

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

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.

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, 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
Caused by increased metabolic needs Septicemia, anemia, and hyperthyroidism

High output failure

CHF, cont.

Compensation how the body responds to maintain adequate cardiac output

Sympathetic Renal Ventricular hypertrophy

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

CHF, cont.

Objective symptoms

Objective symptoms

Left sided failure

Right sided failure

Anxious Pale Tachycardia Dyspnea, with crackles, wheezes Orthopnea Non-productive cough Later productive cough with frothy, bloody sputum Oliguria

Weight gain Pitting, dependent edema JVD Ascites Decreased UOP Distended neck veins N/V, anorexia

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, 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

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