The middle layer of the heart wall that contains cardiac muscle (myocardium) weakens and stretches, causing the heart to lose its pumping strength and become enlarged. The heart remains functional; however, contractions are weak, resulting in decreased cardiac output. Most are idiopathic and not related to the major causes of heart disease. The three types of cardiomyopathy are:
1. Dilated cardiomyopathy (common): The heart muscle thins and enlarges,which leads to congestive heart failure. Progressive hypertrophy and dilatation result in problems with pumping action of ventricles.
2. Hypertrophic cardiomyopathy: The ventricular heart muscle thickens, resulting in outflow obstruction or restriction. There is some blood flow present.
3. Restrictive cardiomyopathy (rare): The heart muscle becomes stiff and restricts blood from filling ventricles, usually as a result of amyloidosis, radiation,or myocardial fibrosis after open-heart surgery.
Nursing Goal for Cardiomyopathy
- Patient alert and oriented
- Skin warm and dry
- Pulses strong and equal bilaterally
- Absence of life-threatening dysrythmias
- Urine output 30 ml/hr
- CVP 2 to 6 mm Hg
- Capillary refill < 3 sec
- BP 90 to 120 mm Hg
- Pulse pressure 30 to 40 mm Hg
Nursing Assessment Cardiomyopathy
- Obtain vital signs every 15 minutes during acute phase.
- Assess the patient for changes in neurological function hourly and as clinically indicated.
- Assess for skin warmth, color, and capillary refill time.
- Assess for chest discomfort because myocardial ischemia may result from poor perfusion.
- Assess heart and lung sounds to evaluate the degree in heart failure.
NURSING DIAGNOSES for Cardiomyopathy
• Activity intolerance
• Impaired gas exchange
• Decreased cardiac output
NURSING INTERVENTION for Cardiomyopathy
• Place patient in a semi-Fowler’s position for comfort, which eases respiratory
• Record intake and output of fluids.
• Monitor vital signs to assess for increased respiratory rate, arrythmias.
• Monitor electrocardiogram to look for changes from previous tracing.
• Explain to the patient: fluids restriction may be necessary as heart failure is
a concurrent disease with dilated cardiomyopathy.
• Record daily weight and call physician if weight increases 3 lbs (1.4 kg).
• No smoking or drinking alcohol.
• No straining during bowel movements.
• Increase exercise.
Medical-Surgical Nursing Demystified