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Cardio Myopathy.pptx
1. Adult Health
Case:A 54-year old male self-presented to the emergency department with a 4-day
history of awareness of irregularities of his heart rhythm. This was not accompanied
by any chest pain but he revealed a one-month history of shortness of breath,
tiredness, and leg swelling.
2. Cardio= Heart Myo= Muscle Pathy: Suffering/Disease
WHO – 1980 – “Heart muscle disease of unknown cause”
WHO & International Society and Federation of Cardiology
Task Force – 1995
“Disease of the myocardium associated with cardiac
dysfunction”
AHA “ A heterogeneous group of disease of the myocardium associated with
mechanical and/or electrical dysfunction that usually (but not invariably) exhibit
inappropriate ventricular hypertrophy or dilatation and are due to a variety of
causes that frequently are genetic.
Cardio-myopathies either are confined to the heart or are part of
generalized systemic disorders, often leading to cardiovascular death or
progressive heart related disability”
6. DILATED CARDIOMYOPATHY
•Most common type
• 5 to 8 cases per 100,000
people per year
•Distinguished by significant
dilatation of the ventricles
without simultaneous
hypertrophy
•The size of ventricular cavity
enlarges with reduced cardiac
output
•Impaired ventricular
contraction leading to
progressive left sided and later
right sided failure
10. showing dilated cardiomyopathy. Note the extremely dilated left
ventricle. The left ventricular end-diastolic dimension was 5.9 cm, and
the ejection fraction was 26%. LV, left ventricle ; RV, right ventricle ; LA,
left atrium ; RA, right atrium.
Two-dimensional echocardiography
11. • There is marked left ventricular hypertrophy with repolarisation abnormality (LV “strain” pattern) in V5-6.
• LV dilatation has produced an interventricular conduction delay mimicking LBBB — however, this is not LBBB as
the morphology is not typical and there are small Q waves in V5-6 (the presence of Q waves in V6 rules out
LBBB).
• There are some signs of left atrial enlargement — leftward deviation of the P wave axis (positive P waves in I
and aVL, inverted in III and aVF) and prolongation of the terminal portion of the P wave in V1.
• Right axis deviation in the presence of LVH suggests the possibility of biventricular enlargement.
• The widespread downsloping ST depression may be due to LVH
Electrocardiogram
14. • Rare autosomal
dominant condition
• Occurs in men, women
and Children
• 0.05% to 0.2% of the
population in US
• 3% of death in young
competitive athletes
• Characterized by thick
ventricle
(symmetrical/asymetric
al) and hypertrophy
HYPERTROPHIC CARDIOMYOPATHY
HCM is a clinically heterogenous, autosomal dominant heart muscle disorder due to
primarily mutations in the genes encoding the cardiac sarcomere myofillament
proteins. This culminates in the proteins altered structure and function with
myofibrillar disarray, marked ventricular hypertrophy (frequently assy metric), diastolic
dysfuction and in some patients, sudden cardiac death as its most devastating
outcome.
19. • Electrocardiogram (ECG) of the HCM subject
showing normal sinus rhythm. ST segment
abnormality and inverted T-wave in Leads I, II, III,
V4, V5 and V6.
21. Collaborative management
• Goal of care are to improve ventricular
filling by reducing ventricular
contractility and relieving LV outflow
obstruction.
• Pharmacological management
- β-adrenergic blockers
- Antidysrhythmic medications
- Anticoagulation
- IE prophylaxis
• Cardioverter defibrilator
• AV pacing
• Surgical management
- Ventriculomyotomy and mectomy
- Percutaneous transluminal septal
myocardial ablation (PTSMA)
22. • characterized by impaired
ventricular filling with normal
ventricular wall thickness and
systolic function
• Abnormal diastolic function
and dilated atrial chambers
• Left sided ventricle
involvement produces
pulmonary venous congestion
and dyspnea
• Right sided presents with signs
of systemic venous congestion
• Classified as Primary and
Secondary
RESTRICTIVE CARDIOMYOPATHY
23. ETIOLOGY Of RCMP
•Idiopathic
•May be associated
with
-Amyloidosis
-Endocarditis fibrosis
-Neoplastic tumor
-Post radiation therapy
-Sarcoidosis
-Ventricular thrombus
25. • RCM is common type of CMP
• Increased stiffness of the myocardium, substance
fibrosis or scaring of endocardium
• Impaired diastolic filling
• Ventricular volumes are usually normal or reduced
• Wall thickness is normal or mildly increased in some
cm
• Systolic function is typically preserved
• Poor ventricular compliance
• Intraventricular pressure rises precipitously with
small increase in volume
27. Chest X-ray
- May be normal
or show
cardiomegaly
from right and
left atrial
enlargement
Electrocardiogram:
- low voltage, conduction defect
-Mild tachycardia at rest
-Supreventricular (atrial fibrillation)
-AV block
29. Collaborative Care
• Aims to improve diastolic filling
and the underlying disease
process.
• Conventional therapy for HF
and dysrythmia
• Heart transplantation may also
be a considerable
30. Arrythmogenic Right Ventricular CMP
• 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 entire
heart is affected.
• RV dilates and develops poor contractility, RV wall
abnormalities and dysrhythmias.
• Palpitation or syncope may develop 15and 40 years
of age
• Should be considered in patient with VT originating
in RV (LBBB) or sudden death among young athlets.
37. Nursing Management
• Decreased CO related to
structural disorders caused by
cardiomyopathy
• Ineffective cardiopulmonary
cerebral peripheral secondary to
renal perfusion related to
decreased peripheral blood flow
• Impaired gas exchange related
to pulmonary congestion caused
by myocardial failure
• Activity intolerance related to
decreased cardiac output
• Anxiety related to change in
health status secondary to role
functioning.
