Cardiomyopathy is a disease of the heart muscle that causes it to become enlarged, thickened, or rigid, preventing it from pumping blood properly. There are several types including dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Symptoms can include fatigue, shortness of breath, chest pain, and fluid retention. Diagnosis involves physical exam, ECG, echocardiogram, cardiac MRI/CT, and biopsy. Treatment may include medications, devices, surgery, or transplantation to improve symptoms and survival. Nursing care focuses on managing symptoms, ensuring proper nutrition and activity, and health education.

1. CARDIOMYOPATHY
DIVYA THAKUR
M.Sc.Nursing 1st Year

3. introduction
Cardiomyopathy
(cardio=heart +myo=muscle + pathy=disease/abnormality) is a
diseased condition in which heart muscle that cannot function
(contract) adequately.
In most cases, cardiomyopathy causes the heart muscle to become
enlarged, thick or rigid. In rare instances, diseased heart muscle
tissue is replaced with scar tissue.

4. definition
• Cardiomyopathy is a weakening of the heart muscle
or another problem with the heart muscle which
often occurs when the heart cannot pump as well as
it should, or with other heart function problems.

5. • Cardiomyopathy is a heart muscle disease associated
with cardiac dysfunction. It is classified according to
the structural and functional abnormalities of the
heart muscle.

6. Pathophysiology
The pathophysiology of all cardiomyopathies is a series of
progressive events that culminate in impaired cardiac output.
Decreased stroke volume
stimulates the sympathetic nervous system and the renin-
angiotensin-aldosterone response
resulting in increased systemic vascular resistance and increased sodium
and fluid retention,

7. which places an increased workload on the heart.
These alterations can lead to heart failure

8. TYPES

9. types
1. Dilated cardiomyopathy(DCM)
2. Hypertrophic cardiomyopathy (HCM),
3. Restrictive or constrictive cardiomyopathy,
4. arrhythmogenic right ventricular cardiomyopathy
(ARVC)

11. DILATED CARDIOMYOPATHY
• DCM is the most common form of cardiomyopathy, with an
incidence of 5 to 8 cases per 100,000 people per year and
increasing
• DCM occurs more often in men
• DCM is distinguished by significant dilation of the
ventricles without significant concomitant hypertrophy (i.e.,
increased muscle wall thickness) and systolic dysfunction.

13. • These structural changes decrease the amount of
blood ejected from the ventricle with systole,
increasing the amount of blood remaining in the
ventricle after contraction.
•Altered valve function can result from the enlarged
stretched ventricle, usually resulting in regurgitation.

14. • More than 75 conditions and diseases may cause DCM,
including pregnancy, heavy alcohol intake, and viral
infection (eg, influenza). When the causative factor cannot
be identified, the term used is idiopathic DCM.
• Idiopathic DCM accounts for approximately 25% of all
heart failure cases

15. HYPERTROPHIC CARDIOMYOPATHY
• In HCM, the heart muscle increases in size and
mass, especially along the septum.

17. The increased thickness of the heart muscle reduces
the size of the ventricular cavities and causes the
ventricles to take a longer time to relax, making it
more difficult for the ventricles to fill with blood
during the first part of diastole and making them
more dependent on atrial contraction for filling.

18. • The increased septal size may misalign the papillary
muscles so that the septum and mitral valve obstruct the
flow of blood from the left ventricle into the aorta during
ventricular contraction.
• Hence, HCM may be obstructive or non obstructive.

19. • Because of the structural changes, HCM had also been
called idiopathic hypertrophic sub aortic stenosis (IHSS) or
asymmetric septal hypertrophy (ASH).

21. RESTRICTIVE CARDIOMYOPATHY
• Restrictive cardiomyopathy (RCM) is characterized
by diastolic dysfunction caused by rigid ventricular
walls that impair ventricular stretch and diastolic
filling .

22. • Because RCM is the least common cardiomyopathy,
representing approximately 5% of paediatric
cardiomyopathies,
• Restrictive cardiomyopathy can be associated with
amyloidosis.

24. ARRHYTHMOGENIC RIGHT
VENTRICULAR CARDIOMYOPATHY
• ARVC occurs when the myocardium of the right ventricle is
progressively infiltrated and replaced by fibrous scar and
adipose tissue.
• Initially, only localized areas of the right ventricle are
affected, but as the disease progresses, the entire heart is
affected

25. • The disease may be genetic (i.e., autosomal
dominant) .
• Family members should be screened for the disease
with a 12-lead ECG, Holter monitor, and
echocardiograph.

27. CAUSES
• Long-term high blood pressure
• Heart tissue damage from a heart attack
• Chronic rapid heart rate
• Heart valve problems
• Metabolic disorders, such as obesity, thyroid
disease or diabetes
• Pregnancy complications
• Drinking too much alcohol over many years
• Use of cocaine & anabolic steroids

28. • Use of some chemotherapy drugs and radiation to
treat cancer
• Certain infections
• Hemochromatosis
• Amyloidosis
• Connective tissue disorders
• Genetic factors

29. Clinical Manifestations
• The patient may have
cardiomyopathy but remain
stable and without symptoms for
many years.
• As the disease progresses there
will be appearance of symptoms
like-
dyspnoea on exertion, fatigue

30. • Patients with cardiomyopathy
may also report paroxysmal
nocturnal dyspnea
• cough (especially with
exertion),
• orthopnoea,(which may lead
to a misdiagnosis of
bronchitis or pneumonia.)

31. Other symptoms include:
• fluid retention
• peripheral edema, and nausea,( which is caused by poor
perfusion of the gastrointestinal system.)

32. • The patient may experience
chest pain, palpitations,
dizziness, nausea, and
syncope with exertion.
• However, with HCM,
cardiac arrest (i.e. sudden
cardiac death) may be the
initial manifestation.

33. Diagnostic evaluations
History & physical examination
X-RAY
ECG
Echocardiogram
Cardiac MRI &CT
Biopsy
Treadmill stress test
Blood tests & genetic screening

34. Medical Management
• Angiotensin-converting enzyme (ACE) inhibitors: To
improve your heart's pumping capability, such as enalapril
(Vasotec), lisinopril (Zestril, Prinivil), ramipril (Altace) and
captopril (Capoten).
• Angiotensin receptor blockers: (ARBs) For those who
can't take ACE inhibitors, such as losartan (Cozaar) and
valsartan (Diovan).

35. • Beta blockers : To improve heart function, such as carvedilol (Coreg)
and metoprolol (Lopressor, Toprol-XL).
• Digoxin (Lanoxin). This drug, also referred to as digitalis, increases
the strength of your heart muscle contractions. It also tends to slow the
heartbeat. Digoxin reduces heart failure symptoms and improves your
ability to live with cardiomyopathy.

36. Diuretics:
Commonly prescribed diuretics for heart failure include
bumetanide (Bumex) and furosemide (Lasix). The drugs
also decrease fluid in your lungs, so you can breathe more
easily.

37. SURGICAL MANAGEMENT
• When heart failure progresses and medical treatment is no longer
effective, surgical intervention, including heart transplantation, is
considered.

38. Septal myectomy:
• This is an open-heart operation in
which the surgeon removes part of the
thickened, overgrown heart muscle wall
(septum) that separates the two bottom
heart chambers (ventricles). Removing
part of this overgrown muscle improves
blood flow and reduces mitral
regurgitation.

39. • Septal ablation. A small portion of the thickened
heart muscle is destroyed by injecting alcohol
through a long, thin tube (catheter) into the artery
supplying blood to that area. This allows blood to
flow through the area.
• Radiofrequency ablation
• Heart transplantation

40. Surgically implanted devices
• Implantable cardioverter-defibrillator
(ICD).
This device monitors your heart rhythm and
delivers electric shocks when needed to control
abnormal heart rhythms. An ICD doesn't treat
cardiomyopathy, but watches for and controls
abnormal rhythms, a serious complication of the
condition.
.

41. • Ventricular assist device (VAD). This helps blood
circulate through your heart. It can be used as a
long-term treatment or as a short-term treatment
while waiting for a heart transplant.
• Pacemaker. This small device placed under the
skin in the chest or abdomen uses electrical
impulses to control arrhythmias.

42. NURSING DIAGNOSES
• Decreased cardiac output related to structural disorders caused
by cardiomyopathy or to dysrhythmia from the disease process
and medical treatments
• Ineffective cardiopulmonary, cerebral, peripheral, and renal
tissue perfusion related to decreased peripheral blood flow
(resulting from decreased cardiac output)
• Impaired gas exchange related to pulmonary congestion caused
by myocardial failure (decreased cardiac output)

43. • Activity intolerance related to decreased cardiac
output or excessive fluid volume or both
• Anxiety related to the change in health status and in
role functioning
• Powerlessness related to disease process

45. SUMMARIZATION
Introduction of cardiomyopathy
Definition
Types
Clinical manifestation
Diagnostic findings
Management
Nursing diagnosis

46. REFRENCES
• Black Joyce M, Hawks Jane Hokanson. Medical-surgical nursing.
vol-1. 7th ed: New Delhi: Elsevier publishers; 1844-49.
• Brunner & Suddarth’s Textbook of medical-surgical nursing; vol-2.
11th ed. New Delhi: Lippincott williams & wilkins; 643-50.
• Davidson’s principles and practice of medicine. 21st ed. Elsevier
publishers;689-95.
• Nancy A, Nechel. Journal of critical care nurse. April 2009:29(2)
• Chintamani(2012) Lewis’s Medical Surgical Nursing Assessment
and Management of clinical problem Barrakhamba Road ,New
Delhi,Elsevier
• www.medscape.com.
• http://www.slideshare.net

47. • Professor Chris Barnard(a South African cardiac surgeon)
performed the first human heart transplant on the third of
December 1967.
• India - With a group of surgeons led by P. Venugopal
successfully performed India’s first heart transplant at the All
India Institute of Medical Sciences (AIIMS) on 3 August 1994.