Cardiomyopathy

Question 1

Cardiomyopathy

Answer 1

Group of diseases that directly affect myocardial structures or function;
heart can’t function right way because shape/structures change & can’t function the way it should

Question 2

Primary

Answer 2

idiopathic

Only involves heart muscle, other heart structures unaffected

Question 3

Secondary

Answer 3

Known cause and is secondary to another disease process

Question 4

Dilated Cardiomyopathy

Answer 4

Most common type
Most common reason patients need heart transplant
Thinned muscle wall, can’t pump effectively and get blood out to organs as it’s supposed to
Can be left or right sided, but most often we see left

Question 5

Dilated Cardiomyopathy SxS

Answer 5

S/S HF
Fatigue
SOB, dyspnea, orthopnea, dry cough
Abdominal bloating, anorexia
Dysrhythmia, heart murmur
Edema
Right side (HF symptoms):
Hepatomegaly 
JVD

Question 6

Dilated C/ Causes

Answer 6

Often follows infectious myocarditis
Cardiotoxic agents: alcohol, cocaine, chemo agents
CAD, pregnancy, HTN, valve disease

Question 7

Dilated C. Complications

Answer 7

Leads to heart failure in 25-40% of cases

Question 8

Dilated. C Diagnostics

Answer 8

Patient history and exclusion of other causes for HF
Echocardiography: basis for majority of Dx
Lab: elevated BNP in presence of HF
Heart catheterization
Ejection fraction (might see 20%, normal is 55)

Question 9

Dilated C. Drug Therapy

Answer 9

To control HF (contractility, preload, afterload):
Nitrates and diuretics: decrease preload
ACE inhibitors: decrease afterload
Beta blockers and aldosterone antagonists control neuro-hormonal stimulation
Antidysrhythmics
Anticoagulants
Dobutamine (dobutrex) (IV inotrope) and milrinone (Primacor): continuous IV, increase contractility

Question 10

Dilated C. Interprofessional Care

Answer 10

Control HF: increase contractility, decrease preload and afterload
Activity:
Reduced physical activity during period of decompensation
Cardiac rehab program to increase exercise tolerance
Diet:
Sodium restriction
Small frequent meals during liver congestion
Increased nutrition (prevent chacexia)
Vitamins; no alcohol

Question 11

Dilated C. Surgical Therapies

Answer 11

Ventricular assist device (VAD): allow heart to recover, bridge to transplant
Implantable defibrillators
Cardiac transplantation – 50% of heart transplants are to treat dilated cardiomyopathy
If not candidate for cardiac transplant, they can have a permanent VAD placed

Question 12

Hypertrophic Cardiomyopathy

Answer 12

Massive ventricular hypertrophy
Rapid forceful contractions of the L ventricle
Impaired relaxation (diastole)
Obstruction to aortic outflow (not always present)
Thickened septum and ventricular wall
Impaired ventricular filling because the ventricle is noncompliant and unable to relax; can get in the way of ejection as well

Question 13

Hypertrophic C. Causes

Answer 13

Familial (genetic basis)
Idiopathic
Sporadic occurrence
Autosomal dominant trait causing encoding of cardiac sarcomere

• Note: this is the disease process that causes sudden cardiac death in young athletes; usually the first sign that they have it

Question 14

Aggravating Factors of Hypertrophic C.

Answer 14

Increase contractility (exercise, + inotropes)
Increased HR (exercise, fever, increased CO)
Deecreased preload (hypovolemia, sepsis, fluid shifts)
Loss of atrial kick (atrial fibrillation, ventricular arrhythmias)
*Arrhythmias may occur and cause sudden death!

Question 15

SxS Hypertrophic C

Answer 15

Sudden death from arrhythmias may be first sign
Exertional dyspnea
Fatigue
Angina 
Syncope

Question 16

Diagnostics Hypertrophic C

Answer 16

Echocardiogram
Clinical findings
Apical impulse is exaggerated and displaced left on palpation
S4, systolic murmur 
Echo may be only indication

Question 17

Goals of Treatment Hypertrophic C

Answer 17

increase ventricular filling by slowing HR, decrease contractility to reduce obstruction

Question 18

Drug Therapy Hypertrophic C

Answer 18

Beta blockers
CCBs
Internal cardiac defibrillator (ICD)
Required for person at risk for sudden cardiac death
AV pacing

Question 19

Surgical Txmt Hypertrophic C

Answer 19

can dissect away some of muscle and it won’t come back
Ventriculomyotomy
Myectomy

Question 20

Restrictive Cardiomyopathy

Answer 20

Rare condition – disease of myocardium that impairs diastolic filling and stretch

Muscle gets stiff, does not work correctly, impairs filling and stretch

Question 21

Restrictive C Causes

Answer 21

Myocardial fibrosis, hypertrophy, and infiltration – stiffness of the ventricular wall with loss of compliance
Amyloidosis, endocardial fibrosis, sarcoidosis, radiation to thorax

Question 22

Clinical Manifestations Restrictive C

Answer 22

Again HF symptoms predominate
RUQ discomfort (right sided failure symptoms predominate vs. left sided symptoms)
Dyspnea (pulmonary congestion)
Chronic fatigue (decreased CO)
Poor exercise tolerance

Question 23

Diagnostics Restrictive C

Answer 23

CXR: normal to cardiomegaly
Echocardiogram: thickened wall
Myocardial biopsy: piece of muscle reveals restricted and stiff

Question 24

Interprofessional Care Restrictive C

Answer 24

No specific treatment; heart failure symptom relief
Symptom relief primarily by decreasing pulmonary/systemic congestion
HF and dysrhythmia treatments
Avoid strenuous activity and dehydration