OM VERMA ASSISTANT PROFESSOR RELIANCE INSTITUTE OF NURSING

2. Cardiomyopathy
PRESENTED BY
MR. OM VERMA
ASSISTANT PROFESSOR
MEDICAL SURGICAL NURSING
RELIANCE INSTITUTE OF NURSING

3. DEFINITION
u Cardiomyopathy is a type of heart
disease in which the heart muscle is
abnormal enlarge thickened and
stiffened as a result the heart
muscle ability to pump blood is usually
impaired .
u JOYCE M BLACK

4. Cardiomyopathy is a wakening of heart
muscle or a change in heart muscle
structure ,it is often associated with
inadequate heart pumping or other
function heart problem .
BRUNNER AND SIDDHARTH

5. Cardiomyopathy is a define as
structural and functional abnormality
of the heart muscle

6.  disease of the heart muscle in which the heart loses its ability to
pump blood effectively
 the heart muscle becomes enlarged or abnormally thick or rigid.
 In rare cases, the muscle tissue in the heart is replaced with scar
tissue.
 As cardiomyopathy progresses  the heart becomes weaker and
less able to pump blood through the body  to heart failure,
arrhythmias, systemic and pulmonary edema and, more rarely,
endocarditis
Cardiomyopathy

7. A primary disorder of the heart
muscle that causes abnormal
myocardial performance and is not
the result of disease or dysfunction
of other cardiac structures …
myocardial infarction, systemic
hypertension, valvular stenosis or
regurgitation”
According to lippin cott

8. 12/98 medslides.com 8
Incidence and Prognosis
3-10 cases per 100,000
20,000 new cases per year in the U.S.A.
death from progressive pump failure
1-year 25%
2-year 35-40%
5-year 40-80%
stabilization observed in 20-50% of
patient complete recovery is rare

9. THE 3 MAIN TYPES OF
CARDIOMYOPATHY ARE:
1. Dilated cardiomyopathy
2. Hypertrophic cardiomyopathy
3. Restrictive cardiomyopathy

11. DILATED CARDIOMYOPATHY
u most common form of cardiomyopathy
u generally occurs in adults aged 20 to 60 years
u more common in men
 the heart muscle begins to dilate or stretch and become thinner

 Ventricular chamber size

over time, the heart becomes weaker  heart failure
 symptoms of heart failure: fatigue, edema, and SOB
 can also lead to heart valve problems (regurgitation),
arrhythmias, and blood clots in the heart (poor blood flow),
emboli formation
 a common reason for needing a heart transplant.

12. It refers to overall enlargement of
the heart chamber especially the
ventricles and increase atrial
chamber size and weakness of heart
muscle and poor pumping .
According to lippin cott

13. Dilated cardiomyopathy (DCM) is when
the heart's ability to pump blood is
lessened because its main pumping
chamber, the left ventricle, is
enlarged and weakened. In some
cases, this prevents the heart from
filling with blood .
According to lewis

15. Types and Causes:
u Ischemic cardiomyopathy - caused by CAD & MI ,
w/c leave scars in the heart muscle Ischemic
cardiomyopathy (IC) is a condition when your
heart muscle is weakened as a result of a heart
attack or coronary artery disease. In coronary
artery disease, the arteries that supply blood to
your heart muscle become narrowed.
u Idiopathic cardiomyopathy - the cause is
unknown.
u Hypertensive cardiomyopathy - seen in people
who have high BP for a long time, particuarly
when it has gone untreated for years.

16. u Infectious cardiomyopathy - HIV, viral myocarditis
u Alcoholic cardiomyopathy - usually begins about 10
years after sustained, heavy alcohol consumption.
u Toxic cardiomyopathy – due to cocaine,
amphetamines, and some chemotherapy drugs
(doxorubicin, daunorubicin)
u Peripartum cardiomyopathy: This type appears in
women during the last trimester of pregnancy or
after childbirth.
u Radiotherapy (cobalt)
u diabetes and thyroid disease

17. HYPERTROPHIC
CARDIOMYOPATHY
Is an overgrowth of heart muscle that can
impair blood flow both in to and out of the
heart and thickened inter ventricular
septum and left ventricular hypertrophy
According to Brunner & Suddarth's

18. Hypertrophic cardiomyopathy (HCM)
is a condition in which a portion of
the heart becomes thickened without
an obvious cause. This results in the
heart being less able to pump blood
effectively. Symptoms vary from
none to feeling tired, leg swelling, and
shortness of breath.
According lippin cott

19. Hypertrophic Cardiomyopathy
 occurs when the heart muscle thickens abnormally (left
ventricle)
 1.) obstructive type - the septum thickens and bulges into the
left ventricle blocks the flow of blood into the aorta  the
ventricle must work much harder to pump blood past the
blockage and out to the body
- symptoms can include chest pain, dizziness, shortness of
breath, or fainting.
- can also affect the mitral valve, causing blood to leak
backward through the valve.
2.) non-obstructive type - the entire ventricle may become
thicker (symmetric ventricular hypertrophy) or it may
happen only at the bottom of the heart (apical hypertrophy).
The right ventricle also may be affected.

21. Pathophysiology:
 Left ventricular hypertrophy (thick ventricular wall)  
ventricular chamber size  hold less blood   CO
  pressure in the ventricles and lungs
 changes in the cardiac muscles  interfere with the heart's
electrical signals, leading to arrhythmias  sudden cardiac arrest
Causes:
u inherited because of a gene mutation
u develop over time because of high blood pressure or aging
u often, the cause is unknown.
Hypertrophic Cardiomyopathy

23. RESTRICTIVE
CARDIOMYOPATHYu
u The ventricles become stiff and rigid due to replacement of the
normal heart muscle with abnormal tissue, such as scar tissue.
u As a result, the ventricles cannot relax normally and expand to fill
with blood, which causes the atria to become enlarged.
u Eventually, blood flow in the heart is reduced, and complications
such as heart failure or arrhythmias occur.
Causes:
u radiation treatments, infections, or scarring after surgery
u Hemochromatosis - a condition in which too much iron is deposited
into tissues, including heart tissue
u Amyloidosis, a disease in which abnormal proteins are deposited into
heart tissue
u Sarcoidosis, a disease in which inflammation produces tiny lumps of
cells in various organs in the body, including the heart

24. Restrictive cardiomyopathy (RCM) is
a form of cardiomyopathy in which
the walls of the heart are rigid (but
not thickened). Thus the heart is
restricted from stretching and filling
with blood properly.
According to lippin cott

25. RESTRICTIVE
CARDIOMYOPATHY
Is the common type of
Cardiomyopathy I n this condition
the heart muscle is too stiff .
According to luckmans

26. ARRHYTHMOGENIC RIGHT
VENTRICLE HYPERTROPHY
Fibrous scar And adipose tissue
covering the right ventricle .

27. u Arrhythmogenic right
ventricular dysplasia (ARVD) is a rare
type of cardiomyopathy. It occurs if the
muscle tissue in the right ventricle dies
and is replaced with scar tissue. This
disrupts the heart's electrical signals
and causes arrhythmias. Symptoms
include palpitations and fainting after
physical activity.

28. ETIOLOGY
Chronic excessive alcohol consumption
INFECTION= viral endocarditis and
myocardaties
Adenovirus
Parvovirus
Human immune deficiency virus
Parasites
protozoa

29. u THIAMINE DEFICIENCY
u Thiamine (vitamin B1) serves as an
important cofactor ( help) in body
metabolism and energy production. a lack
of thiamine affects several organ
systems, in particular the cardiovascular
and nervous system.

30. ZINC DEFICIECY
u Zinc is a vital element in maintaining
the normal structure and physiology
of cells. ... to have protective effects
in coronary artery disease
and Cardiomyopathy.

31. COLLEGEN VASCUL DISEASE
increase connective tissue growth
AUTO IMMUNE DISEASE
GLYCOGEN STORAGE DISEASE

32. u Glycogen storage disease type II, also
called Pompe disease, is an autosomal
recessive metabolic disorder which
damages muscle and nerve cells throughout
the body. It is caused by an accumulation
of glycogen in the lysosome due to
deficiency of the lysosomal acid alpha-
glucosidase enzyme. It is the only glycogen
storage disease with a defect in lysosomal
metabolism,
Con……………………………………………………..plto

33. The build-up of glycogen causes
progressive muscle weakness
(myopathy) throughout the body and
affects various body tissues,
particularly in the heart, skeletal
muscles, liver and the nervous system.

34. AMYLOIDOSIS
Cardiac Amyloidosis ("stiff heart
syndrome") occurs when amyloid deposits
take the place of normal heart muscle. It
is the most typical type of restrictive
cardiomyopathy. Cardiac Amyloidosis may
affect the way electrical signals move
through the heart (conduction system).
This can lead to abnormal heartbeats
(arrhythmias) and faulty heart signals
(heart block).

35. STRESS
is a condition in which intense emotional
or physical stresscan cause rapid and
severe heart muscle weakness
(cardiomyopathy).

36. Other drugs
Exposure to heavy metals such as lead,
arsenic, cobalt, or mercury
Cocaine
Cobalt
Emetine ( amebic dysentery)
Anthracyclines ( antibiotics )

37. Major Risk Factors
uHaving a family history of cardiomyopathy, heart failure, or sudden
cardiac death
uHaving a disease or condition that can lead to cardiomyopathy, such
as:
u Coronary artery disease
u A previous heart attack
u Myocarditis
uDiseases that can damage the heart (for example, hemochromatosis,
sarcoidosis, or amyloidosis)
uLong-term alcoholism
uLong-term high blood pressure
uDiabetes and other metabolic diseases

38. PATHOPHYSIOLOGY
Due to etiological factors
Impaired cardiac output
Decrease stroke volume
( amount of b/d ejected per beat by the lift
ventricle in to arota )

39. u Stimulate the sympathetic nervous system
renin angiotension and aldosterone
response
Result increase systemic valular resistance
Na increase and fluid retention

40. Increase workload of heart
Then lead to Cardiomyopathy

41. Signs and Symptoms
u some have no symptoms in the early stages of the disease
u as cardiomyopathy progresses and the heart weakens, signs and
symptoms of heart failure usually appear.
These signs and symptoms include:
uTiredness
uWeakness
uShortness of breath after exercise or even at rest
uSwelling of the abdomen, legs, ankles, and feet
uOther signs and symptoms: dizziness, lightheadedness, fainting during
exercise, abnormal heart rhythms, murmurs

42. common symptoms are:
Chest pain or pressure (more likely with
exercise)
Cough
Fatigue, weakness, faintness
Irregular or rapid pulse
Loss of appetite
Shortness of breath with activity or
after lying down (or being asleep) for
a while
Swelling of feet and ankles

43. 12/98 medslides.com 43
History and Physical
Examination
Symptoms of heart failure
pulmonary congestion (left HF)
dyspnea (rest, exertional, nocturnal), orthpnea
systemic congestion (right HF)
edema, nausea, abdominal pain, nocturia
low cardiac output
fatigue and weakness
hypotension, tachycardia, tachypnea, JVD

44. 12/98 medslides.com 44
Cardiac Imaging
Chest radiogram
Electrocardiogram
24-hour ambulatory ECG (Holter)
lightheadedness, palpitation, syncope
Two-dimensional echocardiogram
Radionuclide ventriculography
Cardiac catheterization
age >40, ischemic history, high risk profile, abnormal
ECG

45. Interventions
The main goals of treating cardiomyopathy are to:
u Manage any conditions that cause or contribute to the
cardiomyopathy
u Control symptoms so that the person can live as normally as possible
u Stop the disease from getting worse
u Reduce complications and the chance of sudden cardiac death
Medications:
u Diuretics, which remove excess fluid and sodium from the body.
u Angiotensin-converting enzyme (ACE) inhibitors, which lower blood
pressure and reduce stress on the heart.
u Beta-blockers, which slow the heart rate by reducing the speed of
the heart's contractions. These medicines also lower BP
u Calcium channel blockers, which slow a rapid heartbeat by reducing
the force and rate of heart contractions, decrease BP

46. Medications
u Digoxin - increases the force of heart contractions and slows
the heartbeat.
u Anticoagulants, which prevent blood clots from forming.
Anticoagulants are often used in the treatment of dilated
cardiomyopathy.
u Antiarrhythmia medicines, which keep the heart beating in a
normal rhythm.
u Antibiotics, which are used before dental or surgical procedures.
Antibiotics help to prevent endocarditis, an infection of the heart
walls, valves, and vessels.
u Corticosteroids, which reduce inflammation.

47. Surgery
u Septal myectomy
- also called septal myomectomy
- is open-heart surgery for hypertrophic obstructive
cardiomyopathy
- generally used in younger patients and when medicines aren't
working well.
u Procedure:
1. a surgeon removes part of the thickened septum that is bulging
into the left ventricle  this widens the pathway in the
ventricle that leads to the aortic valve and improves blood flow
through the heart and out to the body
2. If necessary, the mitral valve can be repaired or replaced at the
same time. This surgery is often successful, and the person can
return to a normal life with no symptoms.

48. Surgery (cont.)
u Surgically implanted devices.
- Surgeons can place several different types of devices in the
heart to help it beat more effectively.
1. A left ventricular assist device (LVAD)
- helps the heart pump blood to the body
- LVAD can be used as a long-term therapy or as a short-term
treatment for people who are waiting for a heart transplant.
2. An implantable cardioverter defibrillator (ICD)
- is used in people who are at risk of life-threatening arrhythmia
or sudden cardiac death.
- This small device is implanted in the chest and connected to
the heart with wires. If the ICD senses a dangerous change in
heart rhythm, it will send an electric shock to the heart to
restore a normal heartbeat.
u Heart Transplant

49. Left
Ventricular
Assist Device
(LVAD)

51. Lifestyle Changes
uThe doctor may recommend lifestyle changes to manage a condition
that is causing the cardiomyopathy. These changes may help reduce
symptoms. Lifestyle changes may include:
uQuitting smoking
uLosing excess weight
uEating a low-salt diet
uGetting moderate exercise, such as walking, and avoiding strenuous
exercise
uAvoiding the use of alcohol and illegal drugs
uGetting enough sleep and rest
uReducing stress
uTreating underlying conditions, such as diabetes and high blood
pressure

52. Heart Transplant
u an operation in which the diseased heart in
a person is replaced with
a healthy heart from a deceased donor.
u 90% of heart transplants are performed
on patients with end-stage
heart failure ---.

53. u Patients who might not be candidates for heart transplant
surgery, because the procedure is less likely to be successful.
u Advanced age - most transplant surgery isn't performed on
patients older than 70 years.
u Poor blood circulation throughout the body, including the brain.
u Diseases of the kidney, lungs, or liver that can't be reversed.
u History of cancer or malignant tumors.
u Inability or unwillingness to follow lifelong medical instructions
after a transplant.
u Pulmonary arterial hypertension (high blood pressure in the
lungs) that can't be reversed.
u Active infection throughout the body.
Heart Transplant (cont.)

54. u Organs are matched for blood type and size of donor and recipient.
u The Donor Heart
Guidelines on how a donor heart is selected :
 the donor meet the legal requirement for brain death
 consent forms are signed
 younger than 65 years of age
 have little or no history of heart disease or trauma to the chest
 not exposed to hepatitis or HIV
 donor heart must be transplanted w/in 4 hrs. after removal from
the donor
Heart Transplant (cont.)

55. Heart Transplant (cont.)

56. u A bypass machine is hooked up to the arteries and veins of the
heart. The machine pumps blood through the patient's lungs and
body while the diseased heart is removed and the donor heart is
sewn into place.
u Preventing Rejection
Immunosuppressants used: cyclosporine, tacrolimus, MMF
(mycophenolate mofetil), and steroids such as prednisone.
uWatching for Signs of Rejection
u Shortness of breath
u Fever
u Fatigue
u Weight gain
u Reduced amounts of urine
u Preventing Infection
Heart Transplant (cont.)

57. What Are the Risks of a Heart
Transplant?
u Failure of the donor heart
u Primary Graft Dysfunction
u Rejection of the Donor Heart
u Cardiac Allograft Vasculopathy - the walls of the new heart's
coronary arteries become thick, hard, and lose their elasticity.
- can cause heart attack, heart failure, dangerous arrhythmias,
and sudden cardiac arrest
u Complications from medicines - risk of infection, diabetes,
osteoporosis , high blood pressure, kidney damage, and cancer
u Infection
u Cancer – lymphoma and skin cancer (due to suppression of the
immune system)

58. COMPLICATION
Heart failure. Heart failure means
your heart can't pump enough blood
to meet your body's needs. The
thickened, stiffened or weakened
heart muscle due to cardiomyopathy
can become unable to pump or can
stop blood from flowing out of the
heart

59. Valve problems. Because people with
Cardiomyopathy have an enlarged
heart, the heart valves may not close
properly, leading to a backward flow
of blood.
Cardiac arrest and sudden death.