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Chapter 2
•
Cardiovascular Care
49
Differences in Cardiomyopathies
Cardiomyopathy
Type
Mechanism of Heart
Failure
Characteristics
Causes of
Phenotype
Treatment
Clinical
Manifestations
Dilated (DCM)
Impairment of
contractility (systolic
dysfunction)
Dilation and
impaired
contraction of
one or both
ventricles.
Dilation often
becomes severe
and is invariably
accompanied by
an increase in
total cardiac mass
(hypertrophy)
Myocardial
infarctions,
Genetic;
peripartum;
myocarditis;
hemochromatosis;
chronic anemia;
toxicities
(including
adverse effects of
chemotherapeutic
agents such as
doxorubicin and
Adriamycin);
chronic
alcoholism;
sarcoidosis;
idiopathic
Supplemental
oxygen and
assisted ventilation
as needed
Optimizing
hemodynamics
Relief of symptoms
Arrhythmia
management
Device therapy
Antithrombotic
therapy
Signs and
symptoms of
CHF (shortness
of breath, easy
fatigability, and
poor exertional
capacity)
Myocardial
ischemia
Stroke
Sudden death
Dysrhythmias
Cardiac murmur
Hypertrophic (HCM)
Impairment of
compliance (diastolic
dysfunction); intermittent
ventricular outflow
obstruction.
Genetic; Friedreich
ataxia; storage
diseases; infants of
diabetic mother
Restrictive (RCM)
Impairment of
compliance (diastolic
dysfunction)
Nondilated
ventricles
with impaired
ventricular filling
Amyloidosis;
radiation-induced;
idiopathic
Arrhythmogenic
(ARVC)
Rhythm disturbances;
ventricular tachycardia or
fibrillation
Right ventricular
failure
Sudden death in
primarily young
people
Inherited
•
Monitor the patient for signs of
progressive failure (decreased
arterial pulses, increased jugular
vein distention) and compromised
renal perfusion (oliguria, increased
blood urea nitrogen and serum
creatinine levels, and electrolyte
imbalances). Weigh the patient
daily.
•
Administer oxygen as needed.
•
If the patient is receiving a
diuretic, monitor him for signs of
Teaching About
Cardiomyopathy
•
Before discharge,
teach the patient
about the illness
and its treatment.
•
Emphasize the need
to restrict fluid and
sodium intake and monitor for
weight gain.
•
Encourage family members
to learn cardiopulmonary
resuscitation because sudden
cardiac arrest is possible.
LESSON PLANS
resolving congestion (decreased
crackles and dyspnea) or too
vigorous diuresis. Monitor serum
potassium level for hypokalemia,
especially if therapy includes a
cardiac glycoside.
•
Allow the patient and his family
to express their fears and
concerns.
•
Prevent constipation and stress
ulcers to reduce cardiac
workload.