CARDIOMYOPATHIES

HYPERTROPHIC, RESTRICTED AND DILATED

BY: ROSE MARIE LEE

WHAT ARE
CARDIOMYOPATHIES?
a weakening of the heart muscle or

another problem with the heart muscle.

It often occurs when the heart cannot

pump as well as it should, or with other

heart function problems.

They are attributed to intrinsic

myocardial dysfunction.

TYPES OF CARDIOMYOPATHIES:
DILATED
HYPERTROPHIC
RESTRICTIVE
ARRYTHMOGENIC
UNCLASSIFIED

DILATED CARDIOMYOPATHY
Has progressive cardiac dilation and contractile (systolic)

dysfunction.
Associated with mitral or tricuspid regurgitation.
Dilated cardiomyopathy represents the final common

morphologic outcome of various biologic insults. It is a

combination of myocyte injury and necrosis associated
with myocardial fibrosis, which results in impaired
mechanical function.
Many cases are a result of direct toxicity (e.g., alcohol) or

mechanical insults (e.g., chronic volume overload in

mitral valvular regurgitation). With myocyte failure and
cytoskeletal uncoupling, the chambers become dilated

DILATED CARDIOMYOPATHY
ETIOLOGY:
Chronic tachycardia, ,granulomatous

disease
INFECTION (Coxsachie B, T. Cruzi)
Toxoplasmosis
Thyrotoxicosis
Emotional stress, nutritional diseases and

genetics

Signs and symptoms

Left Ventricles

Right Ventricles

Exertional dyspnea, fatigue

Peripheral edema

Chest pain

Neck vein distention

Elevated LV diastolic
pressure

Sudden death due to

ventricular tachyarrythmias

Low cardiac output

Chest pain

diagnosis
Chest X-Ray
ECG
MRI
Coronary Angiography

ECG

Features of ECG
Left atrial enlargement (may progress to atrial

fibrillation
Left ventricular hypertrophy
Left bundle branch block
Left axis deviation
Poor R-wave progression (with QS complexes in V1-

4- pseudo-infarction pattern
Frequent ectopics (seen with sever DCM)
Ventricular dysrhythmias (VT/VF)

DCM affected heart

Medical Management
Lifestyle restriction
Drugs
Heart transplant and left ventricular

assist device
Cardiac resynchronization and

implantable defribrillators
Valvular Replacement
Anticoagulants

HYPERTROPHIC
CARDIOMYOPATHY
marked by ventricular hypertrophy and
diastolic dysfunction without an increased
afterload (aortic stenosis, coarctation of
aorta, systemic hypertension)
There are three prominent histologic

markers of HCM:
Myocardial disarray in cellular

architecture
Small vessel disease responsible for silent

ischemia and
Scarring

HYPERTROPHIC
CARDIOMYOPATHY
Diastolic dysfunction and impaired left

ventricle filling from non- compliant

thickened wall
Left ventricular outflow restriction
FAMILIAL (most commonly)
Cardiomegaly, pheochromocytoma and

neurofibromatosis (rarely)

Signs and Symptoms

Dyspnea, chest pain, palpitations
Syncope
No fatigue (systolic function preserved)
BP and heart rate normal
S4 sound
Septal hypertrophy and systolic ejection-

murmur at left sternal angle in 3rd or 4th

intercostal space.

Diagnosis
Echocardiography:
->asymmetric septal hypertrophy
-> systolic anterior movement of the

mitral valve
-> early aortic valve closure
MRI
Doppler echocardiography

ECG

ECG

Left ventricular hypertrophy criteria

deep anterior lateral TWI

dagger-like Q waves in infero-lateral
leads

HCM affected heart

MEDICAL MANAGEMENT
Drugs
Surgery
Implantable defibrillator
Lifestyle Restriction
Heart Transplant
Mitral Valve Replacement
Ablation of AV node

RESTRICTIVE
CARDIOMYOPATHY
is a rare form of heart disease that is

characterized by restrictive filling of the

ventricles.

In this disease the contractile function of

the heart and wall thickness are usually
normal, but the relaxation of filling phase
of the heart is very abnormal.

This causes a backlog of blood in the

atria, lungs and body causing signs of

heart failure.

RESTRICTIVE
CARDIOMYOPATHY
Caused by genetic abnormalities,

connective tissue disorders,

Tumors
Radiation
Hypereosinophilic syndrome

Signs and Symptoms

(mimics constrictive pericarditis)
Exertional dyspnea
Reapeated lung infections in children
Orthopnea
Peripheral edema
Fatigue
Ventricular arrythmias
Ascites
hepatomegaly

Diagnosis
Echocardiography
MRI
Testing for primary cause

ECG

ECG
Low voltage QRS complexes
Non-specific ST segment / T wave

changes
Bundle branch blocks
Atrioventricular block (3rd degree AV

block may occur in sarcoidosis)

Pathological Q waves
Atrial and ventricular dysrhythmias

RCM affected heart

MEDICAL MANAGEMENT
DRUGS
Depends on underlying causes

NURSING MANAGEMENT
Administer drugs as ordered to promote

adequate heart function

Assess hemodynamic status every 3 hrs or more
Monitor intake and output more closely and

obtain daily weights; institute fluid restrictions as

ordered
Institute continuous cardiac monitoring to

evaluate for arrythmias

Assess patient for adverse drug effects

NURSING MANAGEMENT

Be aware that patients with hypertrophic

cardiomyopathy should not receive
medication that may decrease preload
(diuretics, nitrates), or dopamine and
digoxin

Ausculate for heart and lung sounds

being alert for S3 and S4.

Assist patient with ADLs to decrease

oxygen demand.