The document provides information about cardiomyopathy including its definition, types (dilated, hypertrophic, restrictive), causes, signs and symptoms, risk factors, complications, diagnostic tests, and medical, nursing, and surgical management. It discusses the pathophysiology and details of each type of cardiomyopathy and emphasizes lifestyle changes that can help prevent cardiomyopathy.

2. KRISHNA INSTITUTE OF NURSING
SCIENCES KARAD
SUBJECT:- MEDICAL SURGICAL NURSING
TOPIC:- CARDIOMYOPATHY, DILATED, RESTRICTIVE,
HYPERTROPHIC
PRESENTED BY:-
MS.POOJA MHALATKAR
2ND YEAR MSC(N)
KINS KARAD

3. GENERAL OBJECTIVES
At the end of the class the student will be able to get
detailed knowledge regarding the cardiomyopathy
(dilated, restrictive, hypertrophic).

4. SPECIFIC OBJECTIVES
• At the end of the class the student will be able to:
• Define the cardiomyopathy.
• Explain the different types of cardiomyopathy.
• Explain about the pathophysiology
• List down the causes, signs and symptoms of
cardiomyopathy.

5. • Enlist the risk factors, and its complications of
cardiomyopathy.
• Mention the different Diagnostic tests.
• Discuss about the medical, nursing and surgical
management
• prevention

6. INTRODUCTION
The term “cardiomyopathy” refers to “cardio”
(heart), “myo”(muscle), “pathy” (diseases of).
Cardiomyopathy is a diseases of the heart muscles
that makes it harder for your heart to pump blood
to the rest of your body.
 Cardiomyopathy can lead to heart failure.

7. The main types of cardiomyopathy include dilated
hypertrophic and restrictive cardiomyopathy.
Treatment which might include medications,
surgically implanted devices or, in severe cases, a
heart transplant depends on which type of
cardiomyopathy you have and how serious it is.

8. DEFINITION
Cardiomyopathy is a diseases of the
heart muscle that makes it harder
for your heart to pump blood to the
rest of your body. Cardiomyopathy
can lead to heart failure. The main
types of cardiomyopathy include
dilated, hypertrophic and restrictive
cardiomyopathy.

9. TYPES OF CARDIOMYOPATHY
There are three main types of cardiomyopathy.
Dilated, hypertrophic and restrictive.
 In dilated cardiomyopathy, the ventricles are
enlarge.
 In hypertrophic cardiomyopathy, walls of the
ventricles thicken and become stiff.
 In restrictive cardiomyopathy, the walls of
ventricles become stiff, but not necessarily
thickened.

10. DILATED CARDIOMYOPATHY:-
 In dilated cardiomyopathy, the size of the ventricle
cavity enlarges with reduced cardiac output.
 Contractile function decreases as the myocardial
tissue is destroyed.
 Blood moves more slowly through the left ventricle,
which often results in blood clot formation.

11.  Dilated cardiomyopathy is the most frequent type
of cardiomyopathy and one of the most frequent
causes of heart failure.
 Dilated cardiomyopathy may be hereditary, follow
infectious myocarditis, or be caused by chronic
alcohol or cocaine use, HIV, thiamine or zinc
deficiences, infections or other causes.

13. HYPERTROPHIC CARDIOMYOPATHY:-
Hypertrophic cardiomyopathy is enlargement of the
cardiac muscle wall, often of the septum
(asymmetrical septal hypertrophy) and less common
left ventricle (ventricular hypertrophy).
Hypertrophic cardiomyopathy causes the ventricle
wall to be rigid, which decreases ventricular filling.

14. If an enlarged septum obstructs the outflow of blood
through the aortic valve, it is known as obstructive
hypertrophic cardiomyopathy due to asymmetrical
septal hypertrophy.

16. RESTRICTIVE CARDIOMYOPATHY:-
Restrictive cardiomyopathy impaires ventricular
stretch and limits ventricular filling.
Cardiac muscle stiffness is present with no
ventricular dilation, although systolic emptying of
the ventricles remains normal.

17. restrictive cardiomyopathy is the rarest form of
cardiomyopathy.
It may be caused by infiltrative diseases such as
amyloidosis that deposit the protein amyloid within
the myocardial cells, making the muscle stiff and
resistant to stretching for easy ventricular filling.

19. CAUSES
PRIMARY CARDIOMYOPATHY:-
Refers to those conditions in which the etiology of
the heart diseases is unknown (idiopathic). The heart
muscle in this case is the only portion of the heart
involved, and other cardiac structures are
unaffected.

20. SECONDARY CARDIOMYOPATHY:-
The cause of the myocardial diseases is known and is
secondary to another disease process.

21. CAUSES OF SECONDARY
CARDIOMYOPATHY
• Cardiotoxic agents:- alcohol, cocaine, doxorubicin
(Adriamycin)
• Genetic (autosomal dominant) or familial
• Ischemia (coronary artery diseases)
• Muscular dystrophy
• Hypertension
• Metabolic disorders
• Myocarditis

22. • Pregnancy
• Aortic stenosis
• Amyloidosis
• Neoplastic tumor
• Valve disease
• Endomyocardial fibrosis
• Ventricular thrombus

24. SIGNS AND SYMPTOMS
There might be no signs or symptoms in the early
stages of cardiomyopathy. But as the condition
advances, signs and symptoms usually appear,
including:-
Breathlessness with exertion or even at rest.
Swelling of the legs, ankles and feet.
Bloating of the abdomen due to fluid buildup

25. Cough while lying down
Fatigue
Heartbeats that feel rapid, pounding or flutering
Chest discomfort or pressure
Dizziness, lightheadedness and fainting.

26. RISK FACTORS
There are a number of factors that 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 diseases or an
infection in the heart( ischemic cardiomyopathy).

27. Obesity, which makes the heart work harder
 Long term alcohol abuse.
 Illicit drug use, such as cocaine, amphetamines and
anabolic steroids.
 Certain diseases, such as diabetes, an under or
overactive thyroid gland, or disorder that causes the
body to store excess iron ( Hemochromatosis).

28. Other conditions that affect the heart, such as a
disorder that causes the buildup of abnormal
proteins (amyloidosis), a diseases that causes
inflammation and can cause lumps of cells to grow in
the heart and other organs (sarcoidosis), or
connective tissue disorders.

29. COMPLICATIONS
Cardiomyopathy can lead to other heart conditions,
including:-
HEART FAILURE:-
Your heart can’t pump enough blood to meet your body
needs. Untreated, heart failure can be life threathening.
BLOOD CLOTS:-
Because your heart can’t pump effectively, blood clots
might form in your heart. If clots enter your
bloodstream, they can block the blood flow to other
organs, including your heart and brain.

30. VALVE PROBLEMS:-
Because cardiomyopathy causes the heart to enlarge,
the heart valves might not close properly. This lead to
a backward flow of blood.
CARDIAC ARREST AND SUDDEN DEATH:-
Cardiomyopathy can lead to abnormal heart rhythms.
These abnormal heart rhythms can result in fainting
or, in some cases, sudden death if your heart stops
beating effectively.

31. DIAGNOSTIC TESTS
 Cardiomyopathy is seen on a chest x-ray
examination.
 Echocardiography shows muscle thickness and
chamber size to differentiate between the types of
cardiomyopathy
 Changes related to enlarged chamber size,
tachycardia and dysrhythmias can be seen on the
ECG.

32.  Cardiac catheterization with angiocardiography may
also be useful.
 Cardiovascular magnetic resonance is a newer tool
that is being used that has greater accuracy in
diagnosing cardiomyopathy.

33. MEDICAL MANAGEMENT
Medical management is directed toward determining
and managing possible underlying or precipitating
causes correcting the heart failure with
medications, a low sodium diet, and an exercise rest
regimen and controlling dysrhythmias with
antiarrhythmic medications and possibly with an
implanted electronic device, such as implantable
cardioverter- defibrillator.

34. If patients exhibits signs and symptoms of
congestion, their fluid intake may be limited to 2
liters each day.
 The person with HCM may also have to limit physical
activity to avoid a life threathening dysrhythmia.
 A pacemaker may be implanted to alter the
electrical stimulation of the muscle and prevent the
forceful hyperdynamic contractions that occurs with
HCM.

35. NURSING MANAGEMENT
IMPROVING CARDIAC OUTPUT:-
 Monitor heart rate, rhythm, temperature and
respiratory rate at least every 4 hours.
 Evaluate CVP, pulmonary artery wedge pressure, by
pulmonary artery catheter to assess progress and
effect of drug therapy.
Calculate cardiac output, cardiac index and systemic
vascular resistance.

36.  Observe for changes in CO, such as depressed BP,
change in mental status, decreased output.
 Administer pharmacologic support as directed, and
observe for changes in hemodynamic and clinical
status.
 Administer medications to control or eradicate
dysrhythmias as directed.
 Administer anticoagulations as directed, especially
for patients in artrial fibrillation.

37. REDUCING FATIGUE:-
Make sure that patient and visitors understand the
importance of rest.
 Assist patient in identifying stressors and reducing
their effect (important for patients with
hypertrophic cardiomyopathy because stress
worsens the outflow obstructions).

38. Provide uninterrupted periods, and assist with
ambulation as ordered.
Teach the use of diversional activities and
relaxation techniques to relieve tension.

39. HEALTH EDUCATION:-
Teach about medications such as digoxin.
Take daily only after taking pulse; notify doctor if
pulse is below 60beats/minute.
Report signs of digoxin toxicity anorexia, nausea and
vomiting.
Follow-up for periodic blood levels.
Advise to take low sodium diet.
Advice reporting signs of heart failure weight gain,
edema, shortness of breath, increased fatigue.

40. SURGICAL MANAGEMENT
When heart failure progresses and medical
treatment is no longer effective, surgical
intervention, including heart transplantation, is
considered.
However, because of the limited number of organ
donors, many patients die waiting for
transplantation.

41. In some cases, a left ventricular assist
device(LVAD) is implanted to support the failing
heart until a suitable donor heart becomes available
mechanical assist devices and total artificial hearts.

42. LEFT VENTRICULAR OUTFLOW TRACT
SURGERY:-
When a patient with HCM becomes symptomatic
despite medical therapy and a difference in pressure
of 50mm Hg or more exists between the left
ventricle and the aorta, surgery is considered.
The most common procedure is a myectomy
(sometimes referred to as a myotomy- myectomy), in
which some of the heart tissue is excised.

43. Septal tissue approximately 1 cm wide and deep is
cut from the enlarged septum below the aortic valve.
 The length of septum removed depends on the
degree of obstruction caused by the hypertrophied
muscle.
 Instead of a septal myectomy, the surgeon may
open the left ventricle outflow tract valve to the
aortic valve by removing the mitral valve, chordae,
and papillary muscles.

44. The mitral valve then is replaced with a low profile
disk valve.
The space taken up by the mitral valve is
substantially reduced by the prosthetic valve
compared with the patients own valve, chordae, and
papillary muscles, allowing blood to move around the
enlarged septum to the aortic valve in the area that
the mitral valve once occupied.

45.  The primary complication of both procedures is
dysrhythmia; additional complications as
postoperative surgical complications such as pain,
ineffective airway clearance, deep vein thrombosis,
risk for infection, and delayed surgical recovery.

46. PREVENTION
In many cases, you cant prevent cardiomyopathy. You
can help reduce your chance of cardiomyopathy and
other type of heart diseases by living a heart healthy
lifestyle and making lifestyle choices such as:-
Avoiding the use of alcohol or cocaine.
 Controlling high blood pressure,

47. high cholesterol and diabetes.
Eating a healthy diet.
Getting a regular exercise.
Getting enough sleep.
 Reducing your stress.

48. SUMMARY
Today we have seen regarding,
Definition of cardiomyopathy
Types of cardiomyopathy
Causes, pathophysiology,signs and symptoms , risk
factors of cardiomyopathy
Complications of cardiomyopathy

49. Diagnostic tests
Medical management
Nursing management
Surgical management
 Prevention

50. CONCLUSION
Cardiomyopathy (CMP) constitutes a group of
diseases that directly affect the structural or
functional ability of the myocardium.
In general , when someone refers to a
cardiomyopathy they mean the three common types.
Some people will use cardiomyopathy in reference to
an ischemic cardiomyopathy, which implies that
atherosclerotic coronary diseases has resulted in
left ventricle systolic dysfunction.

51. This is technically Improper use of the term
cardiomyopathy; however, it is much easier to say/
write than “ chronic systolic congestive heart failure
from ischemic heart diseases.”
 Likewise, the term “non-ischemic cardiomyopathy” is
frequently used when the ventricular systolic
function is low from a non-ischemic cause) i.e
(dailated cardiomyopathy).

52. BIBLIOGRAPHY
1. P.Hariprasath, “Textbook of Cardiovascular &
Thoracic Nursing”, First Edition 2016, Jaypee
Brothers Medical Publishers (P) Ltd, page no. 523-
532.
2. Javed Ansari, Davinder Kalir;”Text Book of Medical
Surgical Nursing- I” Part A, Published by PV Books,
2015 edition, Pageno. 17 – 19.

53. 3. Suzanne C. Smelter, Brenda Bare, “Brunner and
Suddarth’s Textbook of Medical Surgical Nursing”,
10th edition, published by Lippincott Williams and
Wilkins, page no.
4. Janice L Hinkle, Kerry H Cheever,” Brunner and
Suddarth’s Textbook of Medical Surgical Nursing”,
volume 1, 13th edition, published by, Wolters Kluwer,
New Delhi, page no.29-31.