I.

Summary
Cardiomyopathy is a progressive condition and represents a collection of diverse diseases
that affect the structure of the heart muscle. Different types of cardiomyopathies affect the heart
in different ways. Depending on the type, heart muscles may scar, thicken, stiffen, thin out, or fill
with substances the body produces that are not normally found in it. Consequently, reduction of
the heart’s ability to pump blood throughout the body happens which can lead to irregular
heartbeats, backup of blood into the lungs or rest of the body, heart failure, or cardiac arrest.
Cardiomyopathies can be acquired, inherited, or of unknown origin (idiopathic in nature).
Acquired CM involves non-genetic causes that lead to chiefly, or even exclusively, cardiac
complications (Brieler et al., 2017). Non-genetic pathologies include hemochromatosis and
amyloidosis. It can also get worse during pregnancy. Meanwhile, inherited CM run in families.
Detection of inherited CM is crucial as it may impact a patient’s treatment plan and that of the
rest of the family. Cardiomyopathy can lead to serious complications including arrythmias,
stroke, and cardiogenic shock. Types include: (1) Dilated CM, which can be genetic or acquired,
is characterized by LV dilatation and systolic dysfunction in the absence of either pressure or
volume overload or CAD sufficient to explain the dysfunction (Merlo et al., 2017); (2)
Hypertrophic CM, the most common type of CM (Brieler et al., 2017) and mostly inherited in
etiology, involves the abnormal thickening of the heart (usually the LV) and can develop at any
age but tends to be more severe if occurred during childhood; (3) Restrictive CM, idiopathic and
a much less common type, is where the heart muscle becomes stiff, scarred, or both and is often
associated with systemic disease; (4) Arrhythmogenic Right Ventricular Dysplasia is an inherited
disease which leads to thinning and ballooning of the ventricular wall, typically in the right
ventricle; (5) Unclassified CM is where other types of CM are included.

Common presentation of CM involves DOB during exercise or normal activity, tiredness,

dizziness, chest pain, heart palpitations, and swelling of hands, abdomen, legs, ankles, or feet.
There is an increased risk of getting CM with patients who have a family history of the disease,
undergo radiation treatment for CA, and have medical conditions such as DM, HIV, thyroid
disease, and Duchenne Muscular Dystrophy among others. It is also age-sensitive with the
conditions more prevalent at a certain age (e.g., hypertrophic CM more common in patients in
their 30’s). There are, however, risk factors that are controllable namely alcohol consumption,
amphetamine and cocaine use, stress, eating habits, and smoking. Echocardiogram, stress test,
blood chemistry, chest x-ray, EKG, genetic screening, cardiac catheterization, CT scan, MRI,
coronary angiography, and heart biopsy are the diagnostic tests ordered for this disease.
Treatment may not cure the problem with the heart, rather the main goals of treatment are to
manage the signs and symptoms, prevent worsening of the condition, and reduce complications.
Medical treatments include diuretics, beta blockers, calcium channel blockers, digoxin, SGLT2
inhibitors, ACE inhibitors, and digoxin. Septal ablation and radiofrequency ablation are the non-
surgical procedures while septal myectomy, heart transplant, and implantations are the surgical
procedures that may be advised. Nursing care revolves around fluid and diet restrictions,
monitoring of signs and symptoms, and rehabilitation.

II. Synthesis and Implications to Nursing Practice

This synthesis would highlight the role of nurses in the prevention and management of
cardiomyopathy.
 A study by Henry (2018) said that nurses are trained to act with and on behalf of their
patients to support them as they move from illness to health. As such, one of the most important
interventions nurses perform is patient teaching. In reference to the summary above, there are
risk factors to cardiomyopathy which the patients could control. Poor eating habits, smoking,
alcohol consumption, high blood pressure, high cholesterol, lack of exercise, and stress
contribute to the acquisition or exacerbation of cardiomyopathy. Most, if not all, of these risk
factors are poorly controlled especially by Filipinos.

In 2021, the Department of Health conducted a health survey which focused on five
associated non-communicable diseases (NCD) risk factors, tobacco use, alcohol use, diet,
diabetes, and hypertension. It revealed that 15.5% of adults are tobacco smokers with 22.6% of it
are men and 8.5% are women. About 40.1% drank alcohol in the last 30 days before the survey
where 51.4% are men and 28.9% are women. Consumption of salty food was high with 60.2% or
three in five Filipinos saying they always or often add salt when cooking or preparing food. One
out of ten Filipinos also reported having been diagnosed with raised blood sugar or diabetes
(14.1% among men and 11.3% among women). One quarter of adult Filipinos (25.8%) reported
ever being told that they were hypertensive by their doctor or health professional.

The World Health Organization, meanwhile, said that a significant proportion of Filipino
adults continue to be exposed to NCD risks of tobacco and alcohol use, unhealthy diets, and
physical inactivity according to the October 2020 press release of Department of Health.

The effects of these risk factors are reversible by modification of daily behavior habits.
For instance, Papacchan (2013) noted in his study that the management of DbCM includes
changes in lifestyle, good glycemic control, treatment of dyslipidemia, coexistent hypertension,
CAD, and medications for heart failure. Jefferies et al. (2010) also said that chronic alcohol
abuse is one of the most important adult causes of dilated cardiomyopathy in developed
countries. Alcohol, taken both acutely and chronically, depresses cardiac contractility by poorly
understood mechanisms, activating the neurohormonal system. The estimated 4-year mortality
rate approaches 50% in patients without complete abstinence after diagnosis.

Nurses came into play informing their patients of its harm and ways to control or prevent
it. A nurse's ability to teach effectively can optimize patients' knowledge, skills, capabilities for
self-care, and ability to make informed choices (Falvo, 2011; London, 2016). While it is a fact
that there are other causes of cardiomyopathy with some being idiopathic and genetic and that
these controllable risk factors are not the only one contributing to the disease progression, it is
imperative to remember that each single contributing factor needs to be addressed; and nurses
play a huge role in effective patient education to benefit their condition and elevate their health-
related knowledge.

III. References
Brieler, J., Breeden, M. A., & Tucker, J. (2017, November 15). Cardiomyopathy: An
overview. American Family Physician. Retrieved from
 https://www.aafp.org/pubs/afp/issues/2017/1115/p640.html?
utm_medium=email&utm_source=transaction
Cardiomyopathy. Centers for Disease Control and Prevention. (2019, December 9). Retrieved
from https://www.cdc.gov/heartdisease/cardiomyopathy.htm
DOH Launches Mobile Phone Survey Part 2 on ncds. Department of Health. (2020, October 9).
Retrieved from https://doh.gov.ph/press-release/DOH-LAUNCHES-MOBILE-PHONE-
SURVEY-PART-2-ON-NCDs
DOH releases Non-Communicable Disease Mobile Phone Survey Results. Department of Health.
(2021, August 17). Retrieved from https://doh.gov.ph/press-release/DOH-Releases-Non-
Communicable-Disease-Mobile-Phone-Survey-Results
Falvo, D. R. (2011). Effective patient education a guide to increased adherence. Jones and
Bartlett.
Henry, D. (2018). Rediscovering the art of nursing to enhance nursing practice. Retrieved from
https://journals.sagepub.com/doi/10.1177/0894318417741117
Jefferies, J. L., & Towbin, J. A. (2010). Dilated cardiomyopathy. The Lancet, 375(9716),
752–762. https://doi.org/10.1016/s0140-6736(09)62023-7
London, F. (2016). No time to teach: The essence of patient and Family Education for Health
Care Providers. PRITCHETT & HULL ASSO.
Merlo, M., Cannatà, A., Gobbo, M., Stolfo, D., Elliott, P. M., & Sinagra, G. (2017). Evolving
concepts in dilated cardiomyopathy. European Journal of Heart Failure, 20(2), 228–239.
https://doi.org/10.1002/ejhf.1103
Pappachan, J. M., Varughese, G. I., Sriraman, R., & Arunagirinathan, G. (2013). Diabetic
cardiomyopathy: Pathophysiology, diagnostic evaluation and Management. World
Journal of Diabetes, 4(5), 177. https://doi.org/10.4239/wjd.v4.i5.177