Cardiomyopathy is used to describe a disorder that affects the heart muscle. It is characterized by the thickening, stretching, and stiffening of the heart, affecting the ability of the heart to pump blood.
Cardiomyopathy can affect anyone at any age and may have no known cause. These are the three major types of cardiomyopathy:
Dilated – This is the most common type of cardiomyopathy and is characterized by rapid degeneration and diffused inflammation of heart fibers, causing ventricular dilation, atrial enlargement, and impaired systolic function. Clinical manifestations include fatigue, decreased exercise capacity, dyspnea at rest, orthopnea, and paroxysmal nocturnal dyspnea. Its causes include:
- Cardiotoxic agents: alcohol, cocaine, doxorubicin
- Coronary artery disease
- Myocardial infarction
- Congenital heart disease
- Complications in pregnancy
Hypertrophic – This type of cardiomyopathy involves left ventricular thickening, reducing the ability to pump blood into the heart and the rest of the body. This can lead to atrial fibrillation or other arrhythmias, heart failure, and stroke. This is a major cause of sudden cardiac death in young adults. Clinical manifestations include syncope, exertional dyspnea, angina, and fatigue. This type of cardiomyopathy is rare and is often inherited.
Restrictive – This is the least common type of cardiomyopathy and involves impaired diastolic filling and stretching due to scarring or stiffening. Clinical manifestations include edema, exercise intolerance, fatigue, and dyspnea. The cause may be idiopathic or result from the following:
- Endomyocardial fibrosis
- Post-radiation therapy
- Ventricular thrombus
The Nursing Process
Cardiomyopathy can be asymptomatic and shortness of breath, fainting spells, or chest pain may only develop in the later stages of the disease. Diagnosis is confirmed through ECG, echocardiogram, stress tests, and more which the nurse may assist with.
In some cases, cardiomyopathy can develop quickly and exhibit severe symptoms and complications. Prompt treatment is essential to control the progression of the disease, reduce the risk of complications, and prevent sudden death.
Nurses plan an essential role in caring for patients with cardiomyopathy from assessment and identification of at-risk individuals to providing treatment such as drug therapy and surgical interventions.
Nursing Care Plans Related to Cardiomyopathy
Decreased Cardiac Output Care Plan
When the heart muscles become stiff, thick, or dilated in cardiomyopathy, cardiac function decreases causing poor cardiac output.
Nursing Diagnosis: Decreased Cardiac Output
- Altered heart rate and contractility
- Disease process
- Inflammation of cardiac muscles
As evidenced by:
- Heart palpitations
- ECG changes
- Dyspnea upon exertion
- Decreased ejection fraction
- The patient will demonstrate adequate cardiac output with blood pressure and heart rate within normal limits
- The patient will report reduced feelings of dyspnea and angina
Decreased Cardiac Output Assessment
1. Assess heart rate, rhythm, and pulses.
To compensate for decreased cardiac muscle contractility, the patient with cardiomyopathy will experience tachycardia. Decreased peripheral pulses are also an indication of decreased cardiac output. Pulses may be irregular or strong beats alternating with weak beats (pulsus alternans).
2. Monitor blood pressure.
Hypotension can occur in advanced cardiac failure when the body is unable to compensate for the loss of cardiac function.
3. Assess and monitor urine output.
With decreased cardiac output, the kidneys will respond by retaining sodium and water, decreasing urine output as fluid shifts onto the tissues.
4. Assess diagnostic studies.
A chest x-ray may show an enlarged heart and pulmonary congestion. ECG can show ST segment depression and T wave flattening due to myocardial oxygen demand.
Decreased Cardiac Output Interventions
1. Encourage the patient to rest.
Rest is essential to improve the efficiency of cardiac contractility and decrease myocardial workload by decreasing oxygen consumption.
2. Provide supplemental oxygen.
Supplemental oxygenation increases oxygen availability for myocardial uptake to prevent hypoxia in patients with cardiomyopathy.
3. Administer medications as indicated.
Medications such as antidysrhythmics, vasopressors, and diuretics can help control the progression of reduced cardiac output.
4. Prepare for pacemaker insertion.
A pacemaker may be required to keep the heart beating in a regular rhythm. The nurse can instruct the patient on precautions following the procedure.
Activity Intolerance Care Plan
Activity intolerance is a classic sign of patients with cardiomyopathy along with other symptoms like dyspnea at rest or on exertion, fatigue, and orthopnea. This is a direct result of decreased cardiac function.
Nursing Diagnosis: Activity Intolerance
- The imbalance between oxygen supply/demand
- Generalized weakness
As evidenced by:
- Abnormal blood pressure response to activity
- Abnormal heart rate response to activity
- Anxiety when activity is required
- Exertional discomfort
- Exertional dyspnea
- Expresses fatigue
- The patient will be able to increase their activity level to perform desired activities
- The patient will demonstrate the ability to climb one flight of stairs without dyspnea
Activity Intolerance Assessment
1. Assess the patient’s response to activities.
Parameters like tachycardia, dyspnea, chest pain, excessive fatigue, diaphoresis, weakness, and syncope can determine the patient’s physiological response to the stress of activity and evaluate ongoing progress or deconditioning.
2. Assess factors that affect the patient’s desired tolerated activity level.
Cardiomyopathies can affect patients of any age. Consider the activity level of patients, especially children and younger adults who enjoy playing and participating in sports.
Activity Intolerance Interventions
1. Assist in self-care while promoting independence when tolerated.
Providing care to the patient ensures that the patient’s needs are met while reducing efforts that compromise cardiac workload. Encouraging participation in self-care activities if tolerated allows the patient to maintain a sense of control and independence.
2. Schedule interventions with rest periods in between.
Scheduling interventions and procedures with rest periods ensures that the patient’s needs are met without increasing oxygen demand and cardiac workload.
3. Monitor for an increasing incidence of activity intolerance.
Increasing activity intolerance may indicate increasing cardiac decompensation.
4. Encourage the patient to adhere to a graded cardiac rehabilitation program.
Patients with cardiomyopathy have irreversible cardiac dysfunction. Adhering to a graded cardiac rehabilitation program can help strengthen cardiac function without overexertion.
Ineffective Tissue Perfusion Care Plan
Patients with cardiomyopathy may display ineffective tissue perfusion as the cardiac function worsens, making it difficult to perfuse other organs.
Nursing Diagnosis: Ineffective Tissue Perfusion
- Disease process
- Decrease cardiac contractility
- Decreased cardiac output
As evidenced by:
(symptoms are dependent on the organ system and may include:)
- Blood pressure alterations
- Altered mental status
- Prolonged capillary refill time
- Abdominal distention
- The patient will maintain perfusion as evidenced by vital signs, urine output, and mental status within normal limits
- The patient will verbalize an understanding of their cardiomyopathy and treatment plan
Ineffective Tissue Perfusion Assessment
1. Review diagnostic tests.
Routine monitoring of echocardiograms, ECGs, and blood work allows the healthcare team to monitor worsening perfusion and intervene appropriately.
2. Assess the patient’s medical, social, and family history.
Cardiomyopathy can be genetic, idiopathic, or occur following an infection or other health condition. A thorough medical history can uncover other conditions that may assist the healthcare team in treating the patient and preventing further complications.
Ineffective Tissue Perfusion Interventions
1. Manage underlying conditions.
Diabetes, HIV, hyperlipidemia, sleep apnea, hypertension, cancer, and more can contribute to ineffective tissue perfusion along with cardiomyopathy. Maintaining strict control of comorbidities is necessary for positive outcomes.
2. Administer medications as ordered.
Vasodilators improve cardiac circulation and minimize blood return to the heart to reduce preload and workload. Beta blockers and calcium channel blockers also widen vessels to improve perfusion.
3. Educate on left ventricular assist devices (LVAD).
LVAD is a surgically implanted pump to assist the left ventricle pump blood. This can be a treatment option for patients with end-stage cardiomyopathy.
4. Instruct the patient on lifestyle changes.
There is no cure for cardiomyopathy but following the treatment plan can help the patient live longer with a better quality of life. Instruct on not smoking, exercising within recommended parameters, reducing stress, limiting alcohol intake, and eating a heart-healthy diet.
References and Sources
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Cardiomyopathy. Centers for Disease Control and Prevention. Page last reviewed: December 9, 2019. From: https://www.cdc.gov/heartdisease/cardiomyopathy.htm
- Cardiomyopathy. Cleveland Clinic. Updated: April 28, 2021. From: https://my.clevelandclinic.org/health/diseases/16841-cardiomyopathy
- CARDIOMYOPATHY. What Is Cardiomyopathy? NIH. National Heart, Lung, and Blood Institute. Last updated on April 19, 2022. From: https://www.nhlbi.nih.gov/health/cardiomyopathy
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- What Is Cardiomyopathy in Adults? American Heart Association. Last Reviewed: May 3, 2022. From: https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults