Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

Chapter 2 • Cardiovascular Care  49

Differences in Cardiomyopathies

Cardiomyopathy Type

Mechanism of Heart Failure Impairment of contractility (systolic dysfunction)

Causes of Phenotype Myocardial infarctions, Genetic;

Clinical Manifestations Signs and symptoms of CHF (shortness of breath, easy fatigability, and poor exertional capacity) Myocardial ischemia Stroke Sudden death Dysrhythmias Cardiac murmur

Characteristics

Treatment

Dilated (DCM)

Dilation and impaired contraction of one or both ventricles. Dilation often

Supplemental oxygen and assisted ventilation as needed Optimizing hemodynamics Relief of symptoms Arrhythmia management

peripartum; myocarditis; hemochromatosis; chronic anemia; toxicities (including adverse effects of chemotherapeutic agents such as doxorubicin and Adriamycin); chronic

becomes severe and is invariably accompanied by an increase in total cardiac mass (hypertrophy)

Device therapy Antithrombotic therapy

alcoholism; sarcoidosis; idiopathic

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 Right ventricular failure Sudden death in primarily young people

Amyloidosis; radiation-induced; idiopathic

Arrhythmogenic (ARVC)

Rhythm disturbances; ventricular tachycardia or fibrillation

Inherited

Teaching About Cardiomyopathy

• 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

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.

• 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