GOVERNMENT COLLEGE OF

NURSING, JAGDALPUR

M.SC. NURSING 1ST YEAR

BATCH 2021-23
SUBJECT: MEDICAL SURGICAL NURSING
SEMINAR
ON
CARDIOMYOPATHY

SUBMITTED TO
Ms. Pooja Madam SUBMITTED BY
[Demonstrator] Ms. Yogita Rani Dewangan

Dept. – Medical Surgical Nursing M.Sc. Nursing 1st Year

Government College of Nursing Government College of Nursing

Jagdalpur Jagdalpur

CARDIOMYOPATHY
INTRODUCTION

Cardiomyopathy (kahr-dee-o-my-OP-uh-thee) is a disease of the heart muscle that makes

it harder for the heart to pump blood to the rest of the body. Cardiomyopathy can lead to heart
failure. Cardiomyopathy refers to conditions that affect the myocardium (heart muscle).
Cardiomyopathy can make your heart stiffen, enlarged or thickened and can cause scar tissue. As
a result, your heart can’t pump blood effectively to the rest of your body. In time, your heart can
weaken and Cardiomyopathy can lead to heart failure. Cardiomyopathy damages the muscle tone
of the heart and reduces its ability to pump blood to the rest of the body. This can lead to heart
failure, arrhythemia, fluid building in the lungs or legs, and more rarely endocarditis.

Cardiomyopathy can be classified as primary or secondary. Primary Cardiomyopathy

can’t be attributed to a specific cause and secondary Cardiomyopathy is due to specific cause.
It’s often associated with disease involving other organs as well as heart.

Cardiomyopathies include a variety of myocardial disorders that manifest with various

structural and functional phenotypes and are frequently genetic. Although some have defined
cardiomyopathy to include myocardial disease caused by known cardiovascular causes (such as
hypertension, ischemic heart disease, or valvular disease), current major society definitions of
cardiomyopathy exclude heart disease secondary to such cardiovascular disorders.

REVIEW OF HEART MUSCLE:

Heart walls

Your heart walls are the muscles that contract (squeeze) and relax to send blood throughout your
body. A layer of muscular tissue called the septum divides your heart walls into the left and right
sides. Your heart walls have three layers:

 Endocardium: Inner layer.

 Myocardium: Muscular middle layer.
 Epicardium: Protective outer layer.

The epicardium is one layer of your pericardium. The pericardium is a protective sac that covers
your entire heart. It produces fluid to lubricate your heart and keep it from rubbing against other
organs.

DEFINITION:
“In 1980, the World Health Organization (WHO) defined cardiomyopathies as "heart muscle
diseases of unknown cause" to distinguish cardiomyopathy from cardiac dysfunction due to
known cardiovascular entities such as hypertension, ischemic heart disease, or valvular disease.
In clinical practice, however, the term "cardiomyopathy" has also been applied to diseases of
known cardiovascular cause (eg, "ischemic cardiomyopathy" and "hypertensive
cardiomyopathy").”

“The 1995 WHO/International Society and Federation of Cardiology (ISFC) Task Force on
the Definition of the Cardiomyopathies expanded the classification to include all diseases
affecting heart muscle and to take into consideration etiology as well as the dominant
pathophysiology.”

“In this 1995 definition, the cardiomyopathies were defined as "diseases of the myocardium
associated with cardiac dysfunction." They were classified according to anatomy and physiology
into the following types, each of which has multiple different causes.”

“Cardiomyopathy is a group of diseases that affect the heart muscle. Early on there may be few
or no symptoms. As the disease worsens, shortness of breath, feeling tired and swelling of the
legs may occur, due to the onset of heart failure.  An irregular heart beat and fainting may occur.
Those affected are at an increased risk of sudden cardiac death.”

INCIDENCE:
Cardiomyopathy often goes undiagnosed, so the numbers can vary. As many as 1 of 500 adults
may have this condition. Males and females of all ages and races can have cardiomyopathy.
Dilated cardiomyopathy is more common in blacks than in whites and in males than in females.

Hypertrophic cardiomyopathy is thought to be the most common inherited or genetic heart

disease. While this type of cardiomyopathy occurs at many ages, in children and young adults
with this condition there may be no symptoms, yet they are at high risk of sudden cardiac death.

In the absence of contemporary, population-based epidemiological studies, estimates of the

incidence and prevalence of the inherited cardiomyopathies have been derived from screening
studies, most often of young adult populations, to assess cardiovascular risk or to detect the
presence of disease in athletes or military recruits. The global estimates for hypertrophic
cardiomyopathy (1/500 individuals), dilated cardiomyopathy (1/250) and arrhythmogenic right
ventricular cardiomyopathy (1/5,000) are probably conservative given that only individuals who
fulfil diagnostic criteria would have been included. Between 2008 and 2015, a total of 326,461
distinct patients had cardiomyopathy-related hospitalizations. According to the
Pediatric Cardiomyopathy Registry, the estimated incidence of hypertrophic cardiomyopathy is 5
per 1 million children. 
 Classification:

MAJOR TYPES OF CARDIOMYOPATHY

 Dilated cardiomyopathy-  In this type of cardiomyopathy, the heart's main pumping
chamber — the left ventricle — becomes enlarged (dilated) and can't effectively pump
blood out of the heart.

Although this type can affect people of all ages, it occurs most often in middle-aged
people and is more likely to affect men. The most common cause is coronary artery
disease or heart attack. However, it can also be caused by genetic changes.

 Hypertrophic cardiomyopathy- This type involves abnormal thickening of the heart

muscle, which makes it harder for the heart to work. It mostly affects the muscle of the
heart's main pumping chamber (left ventricle).

Hypertrophic cardiomyopathy can develop at any age, but the condition tends to be more
severe if it occurs during childhood. Most people with this type of cardiomyopathy have a
family history of the disease. Some genetic changes have been linked to hypertrophic
cardiomyopathy.

 Restrictive cardiomyopathy- In this type, the heart muscle becomes stiff and less
flexible, so it can't expand and fill with blood between heartbeats. This least common
type of cardiomyopathy can occur at any age, but it most often affects older people.

Restrictive cardiomyopathy can occur for no known reason (idiopathic), or it can by

caused by a disease elsewhere in the body that affects the heart, such as amyloidosis.

 Arrhythmogenic right ventricular dysplasia - In this rare type of cardiomyopathy, the

muscle in the lower right heart chamber (right ventricle) is replaced by scar tissue, which
can lead to heart rhythm problems. It's often caused by genetic changes.

 Unclassified cardiomyopathy- Other types of cardiomyopathy fall into this category.

World Health Organization classification of Cardiomyopathy:

Types of Causative Factors Features

Cardiomyopathy

Dilated Ischemic, idiopathic, familial-genetic, Dilated left or both

immune, alcoholic, toxic, valvular ventricles with impaired
contractions

Hypertrophic Familial with autosomal dominant Left or right ventricle

inheritance hypertrophy or both

Restrictive Idiopathic, amyloidosis, endomyocardial Restrictive feeling and

fibrosis reduce diastolic feeling of
none or boy ventricles;
normal or near normal
systolic function

Arrhythmogenic Right Unknown; familial, usually autosomal Fibrofatty replacement of

Ventricular dominant inheritance, with incomplete right ventricular
Cardiomyopathy penetrance; possible autosomal myocardium
recessive inheritance; rare form
associated with typical phenotype

Unclassified Fibroelastosis, Noncompacted Non typical for previous

Myocardium Systolic dysfunction with four groups
minimum dilation mitochondrial disease
Other types of cardiomyopathy

Most of the following types of cardiomyopathy belong to one of the previous four
classifications, but each has unique causes or complications:

 Peripartum cardiomyopathy- Peripartum cardiomyopathy occurs during or after

pregnancy. This rare type occurs when the heart weakens within 5 months of delivery or
within the final month of pregnancy. When it occurs after delivery, it’s sometimes called
postpartum cardiomyopathy. This is a form of dilated cardiomyopathy, and it’s a life
threatening condition. Having it once increases your risk with other pregnancies.
 Alcoholic cardiomyopathy-  Alcoholic cardiomyopathy is due to drinking too much
alcohol over a long period of time, which can weaken your heart so it can no longer pump
blood efficiently. Your heart can also become enlarged. This is a form of dilated
cardiomyopathy.
 Ischemic cardiomyopathy-  Ischemic cardiomyopathy occurs when your heart can no
longer pump blood to the rest of your body due to coronary artery disease. Blood vessels
to the heart muscle narrow and become blocked. This keeps oxygen from getting to the
heart muscle. Ischemic cardiomyopathy is a common cause of heart failure. Alternatively,
non ischemic cardiomyopathy is any form that isn’t related to coronary artery disease.
 Non compaction cardiomyopathy- This is also known as spongiform cardiomyopathy.
It’s a rare disease present at birth and is caused by abnormal development of the heart
muscle in the womb. Diagnosis may occur at any stage of life.
 Pediatric cardiomyopathy- When cardiomyopathy affects a child, it’s called pediatric
cardiomyopathy.
 Idiopathic cardiomyopathy- If you have idiopathic cardiomyopathy, it means the cause
is unknown.
 Broken heart syndrome (stress-induced or cardiomyopathy)- Temporary heart
enlargement.
 Chemotherapy-induced cardiomyopathy- Heart damage related to cancer treatment.
RISK FACTORS:

There are a number of things that can increase your risk of cardiomyopathy, including:

 Family history of cardiomyopathy, heart failure and sudden cardiac arrest

 Long-term high blood pressure

 Conditions that affect the heart, including a past heart attack, coronary artery disease or an
infection in the heart (ischemic cardiomyopathy)

 Obesity, which makes the heart work harder

 Long-term alcohol misuse

 Illicit drug use, such as cocaine, amphetamines and anabolic steroids

 Treatment with certain chemotherapy drugs and radiation for cancer

 Diabetes

 Storage of excess iron in the body (hemochromatosis)

 Amyloidosis

 Sarcoidosis

 Connective tissue disorders

 Coronary artery disease

 Damage to the heart due to a heart attack

 Infections that cause inflammation of the heart

 Heart valve disorders

 COVID-19 infection

 Thyroid disease

 Some types of cancer medications

 Exposure to toxins, such as poison or heavy metals

  HIV and HIV treatments

CAUSES:
CAUSE DISORDERS

Cardiovascular System  Ischemia heart disease

Metabolic
Infectious, Inflammatory
 Long term high blood pressure
 Valvular disorder
 Idiopathic dilated cardiomyopathy
 Idiopathic restrictive cardiomyopathy
 Cardiac amyloidosis
 Heart tissue damage from a previous heart attack
 Chronic rapid heart rate
 Starvation, vitamin and mineral deficiency such as
thiamin, selenium, calcium and magnesium
 Diabetes, hyperthyroidism & hypothyroidism,
acromegaly, pheochromocytoma
 Glycogen storage disease
 Secondary amyloidosis, sarcoidosis
 HIV, hepatitis C
 Chagas’ Disease (protozoal)

Genetics  Familial dilated cardiomyopathy

 Familial cardiac amyloidosis
 Noncompacted myocardium
 Systolic dysfunction without dilation
 Arrhythmogenic right ventricular cardiomyopathy
 hemochromatosis
Tachycardia  tachycardia- induced cardiomyopathy

pregnancy  Peripartum cardiomyopathy

Toxic  Excessive use of alcohol

 Abuse of cocaine or antidepressant medication
 Use of some chemotherapy drugs to treat cancer
Sign and symptoms:

 Breathlessness with activity or even at rest

 Swelling of the legs, ankles and feet

 Bloating of the abdomen due to fluid buildup

 Cough while lying down

 Difficulty lying flat to sleep

 Fatigue, palpitation

 Heartbeats that feel rapid, pounding or fluttering

 Chest discomfort or pressure

 Dizziness, Lightheadedness and fainting

 Chest pain

 Tiredness and weakness

 Arrhythmias

 Heart murmur

 Dizziness, lightheadedness and fainting

 high blood pressure

 Syncope (fainting)
Diagnostic Evaluation:

 Personal medical history

 Family medical history

 Physical examination

 diagnostic tests and procedures

 Blood test- Blood tests can provide information about your heart and also help rule out

other conditions.

 Coronary angiography- With coronary angiography, your doctor injects dye into your

bloodstream to look at the flow of blood through your arteries and heart.
 Ambulatory monitoring- uses devices that track your heart rhythm.
 Cardiac CT - uses X-rays to make a video of your blood vessels and heart.
 Cardiac MRI - uses radio waves and magnets to create images of your heart.
 Echocardiogram - uses sound waves to create an image of your blood flow and
heartbeat.
 Electrocardiogram (EKG) - records your heart’s electrical activity.
 Exercise stress test - raises your heart rate in a controlled way to see how your heart
responds.
 Cardiac catheterization- uses a catheter (thin tube inserted through a blood vessel) to
measure your heart’s blood flow and pressure.
 Myocardial biopsy- studies a small sample of your heart muscle tissue to look for cell
changes.

 Stress test- A stress test gauges your heart function while you exercise.

 Holter monitor- A Holter or event monitor can measure your heart’s electrical activity

over 24 or 48 hours.
 Medical Management

Cardiomyopathy treatment focuses on controlling symptoms. Treatment also slows the disease’s
progression. Healthcare provider may recommend:

 Medications: Heart medications can improve blood flow, control symptoms or treat

underlying conditions. Reduce complication and chance of sudden cardiac death.
Recommended blood thinners and other medications are:

o Warfarin (Coumadin®),
o Beta blockers such as propranolol (Inderal®)
o Medications to lower cholesterol
o Vasodilators
o Digitalis (digoxin)
o Beta-blockers
o Calcium-channel blockers
o ACE(Angiotensin Converting enzyme) Inhibitors
o Anticoagulants
o Diuretics
o Anti-Arrhythmia medicines

Surgical Management:

1. Septal myectomy: this is an open heart surgery in which the surgeon removes part of the
thickened, overgrown heart muscle wall (septum) that separates the two bottomheart
chambers (ventricles). Removing part of this overgrown muscle improves blood flow and
reduces mitral regurgitation.
2. Septal Ablation: also called septal alcohol ablation, this is a treatment in which a small
portion of the thickened heart muscle is destroyed by injecting alcohol through a catheter
into the artery supplying blood to it.
3. Pacemaker implantation: a pacemaker is small electronic device insertd under skin that
sends electrical signals to heart to monitor and regulate heart beat. Surgery to implant
pacemaker is usually performed during local anesthesia and typicallytakes less than three
hours.
4. Implantable cardioverter: Defibrillator(ICD): THIS IS A PAGER SIZED DEVICE
implanted in chest like a pacemaker. An ICD continuous monitors heartbeat. If a life
threatening arrhythmia occurs, the ICD delivers precisely calibrated electrical shock to
restore a normal heart rhythm.
 5. Heart transplant: in this surgery, a Doctor replaces a person’s diseased heart with a
healthy heart from a person who has recently died. it is a last resort for people with heart
failure when all other treatment have failed.

Complications:

Cardiomyopathy can lead to serious complications, including:

 Heart failure - The heart can't pump enough blood to meet the body's needs. Untreated,
heart failure can be life-threatening.

 Blood clots - Because the heart can't pump effectively, blood clots might form in the heart.
If clots enter the bloodstream, they can block the blood flow to other organs, including the
heart and brain.

 Heart valve problems- Because cardiomyopathy causes the heart to enlarge, the heart
valves might not close properly. This can cause blood to flow backward in the valve.

 Cardiac arrest and sudden death- Cardiomyopathy can trigger irregular heart rhythms
that cause fainting or, in some cases, sudden death if the heart stops beating effectively.

Prognosis:

Cardiomyopathy is a serious condition. Without treatment, it can be life-threatening.

Cardiomyopathy is also a progressive condition, meaning it usually worsens over time.

Cardiomyopathy treatment can improve your outlook. If you have cardiomyopathy, seek
treatment from a cardiologist (heart specialist). Medication, surgery or other treatments can
increase your quality of life and help you live longer.
Prevention:

If cardiomyopathy runs in your family, you may not be able to completely prevent it. But, you
can take steps to keep your heart healthy and minimize the impact of this condition.

Even if cardiomyopathy isn’t part of your family history, it’s still important to take steps to make
sure you don’t develop a heart condition or disease that could put you at an increased risk of
cardiomyopathy.

The Steps Trusted Source you can take to help lower your risk of cardiomyopathy includes:

 Getting regular exercise-Try to limit how much you sit each day, and focus on getting at
least 30 minutes of exercise most days of the week.
 Getting enough sleep-Sleep deprivation is linked to an increased risk of heart disease.
Try to get at least 7 to 8 hours of sleep each night.
 Eating a heart-healthy diet- Try to limit your intake of sugary, fried, fatty, and
processed foods. Focus instead on fruits, vegetables, whole grains, lean proteins, nuts,
seeds, and low fat dairy. Also limit your intake of salt (sodium), which can raise your risk
of high blood pressure.
 Reducing your stress levels- Try to find healthy ways to lower your stress when
possible. You may want to consider taking regular brisk walks, doing deep breathing
exercises, meditating, doing yoga, listening to music, or talking with a trusted friend.
 Quitting smoking, if you smoke- Smoking can negatively affect your entire
cardiovascular system, including your heart, blood, and blood vessels.
 Managing underlying health conditions- Work closely with your doctor to control and
manage any underlying health conditions that may raise your risk of cardiomyopathy.
 Avoiding the use of alcohol or cocaine

 Controlling high blood pressure, high cholesterol and diabetes

 Nursing management
Acute Patient Care Management

 Outcome Criteria

 Patient alert and oriented

 Skin warm and dry
 Pulses strong and equal bilaterally
 Capillary refill < 3 sec
 BP 90 to 120 mm Hg
 Pulse pressure 30 to 40 mm Hg
 HR 60 to 100 beats/min
 Absence of life-threatening dysrythmias
 Urine output 30 ml/hr
 CVP 2 to 6 mm Hg

 Patient Monitoring

 Obtain Bp hourly or more frequently if the patient’s condition is unstable.

 Monitor hourly urine output to evaluate effects of decreased cardiac output or
pharmacologic intervention.
 Analyze ECG rhythm strip at least every 4 hours and note rate.
 Continuously monitor oxygen status with pulse oximetry.
 Monitor patient activities and nursing interventions that may adversely affect oxygenation.

 Patient Assessment

 Obtain vital signs every 15 minutes during acute phase.

 Assess the patient for changes in neurological function hourly and as clinically indicated.
 Assess for skin warmth, color, and capillary refill time.
 Assess for chest discomfort because myocardial ischemia may result from poor perfusion.
 Assess heart and lung sounds to evaluate the degree in heart failure.

 Patient Management

 Provide oxygen at 2 to 4 L/min to maintain or improve oxygenation.

 Minimize oxygen demand by maintaining the patient at bed rest.
 Provide liquid diet on acute phase,
 Administer diuretic as prescribed to reduce preload and afterload.
 Monitor serum potassium before and after administration of loop diuretics.
 Prophylactic heparin may be ordered to prevent thromboembolus formation secondary to
venous poisoning.
 Institute pressure ulcer prevention strategies secondary to hypoperfusion or vasoconstriction
agents.
Nursing Diagnosis:

1. Decreased cardiac output related to damage heart muscle as evidenced by irregular

heartbeat, heart rate of 128, Dyspnea upon exertion and fatigue.
2. Impaired gas exchange related to alveolar edema due to increased left ventricular
pressure as evidence by shortness of breath,SpO2 level of 85% and crackles upon
auscultation.
3. Activity intolerance related to an imbalance between oxygen supply and demand
secondary to cardiomyopathy as evidence by displayed weakness, fatigue, changes in
vital signs, and the presence of dysrhythmias.
4. Excess fluid volume related to reduced glomerular filtration rate and decreased cardiac
output secondary to cardiomyopathy as evidence by Oliguria, presence of edema, jugular
vein distention and positive hepatojugular reflex.
5. Ineffective tissue perfusion related to decreased cardiac output secondary to
cardiomyopathy as evidence by generalized weakness, chest pain, dysrhythmias,
compromised breathing, altered vital signs, and the presence of pitting edema on the
patient limbs.
 BIBLIOGRAPHY

BOOK REFERENCE:

1. ASHALATHAGDEEPA : TEXTBOOK OF ANATOMY AND PHYSIOLOGY FOR

NURSES, PUBLISHED BY JAYPEE, 1ST EDITION, PAGE NO- 333

2. BRUNNER&SUDDARTH : TEXTBOOK OF MEDICAL SURGICAL NURSING,

PUBLISHED BY LWW, 11TH EDITION, PAGE NO.- 925-933

3. CHINTAMANI : TEXTBOOK OF MEDICAL SURGICALNURSING, PUBLISHED

BY ELSEVIER, 1ST EDITION, PAGE NO.- 881

4. LIPPINCOTT : TEXTBOOK OF MANNUAL OF NURSING PRACTICE PUBLISHED

BY LWW, 10TH EDITION, PAGE NO.- 1542-1545

5. LUCKMANN’S : TEXTBOOK OF CORE PRINCIPLE AND PRACTICE OF

MEDICALSURGICAL NURSING PUBLISHED BY ELSEVIER, PAGE NO.- 744-748

6. P.HARIPRASTH : TEXTBOOK OF CARDIOVASCULAR AND THORACIC

NURSING, PUBLISHED BY JAYPEE, 1ST EDITION, PAGE NO.- 212

7. ROSS&WILLSON : TEXTBOOK OF ANATOMY AND PHYSIOLOGY IN HEALTH

AND ILLNESS, PUBLISHED BY ELSEVIER, 13TH EDITION, PAGE NO. - 81

NET REFERENCE:

 www.mayoclinic.org

 www.cleveland.com

 www.healthline.com
 https://www.wikipedia.com