Question

what are the differences between dilated, hypertrophic, and restrictive cardiomyopathy, and what type of patient it might affect? What are the differences and how would you as a nurse change your plan of treatment, tests, lab, medication, etc.? What changes might you see in their EKG tracing? What is EF or ejection fraction? How is this affected their disease process? What is BNP (B-type natriuretic peptide) what are the significance and the level?

Answer 1

CARDIOMYOPATHY

Cardiomyopathy is a broad term that includes sub acute or chronic disorders of the myocardium (heart muscles ),which make it difficult for the heart to deliver blood to the body and can lead to heart failure.

There are three major types;

Dialated (Congestive)

Hypertrophic

Restrictive

MAJOR DIFFERENCES DIFFERENCES IN THE THREE TYPES OF CARDIOMYOPATHY.

Dialated Restricted Hypertrophic   

Manifestations   

Heart failure,particularly left sided. Right sided heart failure Dyspnea,angina pectoris

Fatigue and weakness. Dyspnea,fatigue Fatigue,syncope,palpation.

Systemic or pulmonary emboli.

Physical Examination   

Moderate to severe cardiomegaly:S3 mild to moderate cardiomegaly;S3 Mild cardiomegaly

and S4 Atrioventricular valve or S4 Atrioventricular valve regurgitation; Apical systolic thrill and

regurgitation (Exspecially mitral) inspiratory increase in venous pressure heave ; brisk carotid

(Kussmaul's sign).    upstroke;S4 common

systolic murmer that

increase with valsalva

maneuver

Chest x-ray study mild cardiac enlargement mild to moderate cardiac -

moderate to marked cardiac    pulmonary venous hypertension enlargement,paroxysmal -

enlargement,especially left- nocturnal dyspnea

ventricular,pulmonary venous- Left atrial enlargement

hypertension

Electrocardiogram

Sinus tachycardia   Low voltage intraventricular Left ventricular hypertrophy   

Atrial and ventricular-    conduction defects,Atrioventricular ST-segment and T-wave   

dysrhythmias ST- segment and conduction defect. abnormalities

T- wave abnormalities.    Abnormal Q-waves  

Intraventricular conduction defects Atrial and ventricular

dysrhythmias.

RISK FACTORS(TYPES OF PATIENTS MIGHT IT AFFECT)

The risk of cardiomyopathy increases in client who ;

Chronically ingest alcohol.

pregnant

Have systemic hypertension.

Have had some kind of infections

WHAT IS EJECTION FRACTION?

An ejection fraction is a measurement of blood pumps out by the left ventricle with each contraction .Expressed in percentage.

Normal rate-5%-70 %

EF l 41-49 % -borderline(indicated damage of heart)

EF less than 40% -indicates heart failure or cardiomyopathy

*CHANGES IN THE EKG ALREADY DISCUSSED ABOVE.

B-natriurectic peptide

A hormone secreted by cardiomyocytes in the heart ventricle and cause increased ventricular blood volume.

greater than 100pg/ml for 0-74 years- abnormal

NURSING INTERVENTIONS OF PATIENTS WITH CARDIOMYOPATHY.

it varies with patient symptoms but, general interventions include,

Provide oxygen at 2 to 4 L/ mt.

Provide liquid diet on acute phase.

Administer diurectic as prescribed to reduce preload and afterload.

ECG monitoring.

Assess chest discomfort

Assess skin for redness.

Patients with restricted cardiomyopathy focus on psychological support because of poor prognosis.