Topic: NSG 430: Critical Care Nursing

Question

Details: Know the differences between dilated, hypertrophic, and restrictive cardiomyopathy and what type of patient it might affect. What are the differences and how would you as a nurse change your plan of treatment, tests, lab, medication, etc.? What changes might you see in their EKG tracing? What is EF or ejection fraction? How is this affected by their disease process? What is BNP (B-type natriuretic peptide) what are the significance and the level?

https://www.mayoclinic.org/diseases-conditions/cardiomyopathy/symptoms-causes/syc-20370709

https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/cardiomyopathy/types.html

http://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults

Please respond to my peer discussion post based on the topic and website information provided above.
The difference between dilated, hypertrophic and restrictive cardiomyopathy is that; dilated cardiomyopathy results from dilated left or right ventricles that increase ventricular systolic pressure with an injection fraction less than 40 % as a result of necrosis of the myocardial tissue, due to impaired myocardial functioning. Causative factors include valvular, ischemia, idiopathic, genetic, immune, toxic, and alcoholic causative factors.

Whereas hypertrophic cardiomyopathy affects the left or both ventricles due to autosomal dominant inheritance of heart disease. Moreover, atrial fibrillation is a common manifestation of hypertensive heart disease. Hypertensive heart disease is the leading identifiable cause of hypertrophic cardiomyopathy failure in older women. Furthermore, causes such as aortic stenosis, aortic regurgitation, mitral valve regurgitation that increase pressure and volume overload.

Restrictive cardiomyopathy results from restrictive and reduced diastolic filling in one or both ventricles; with normal or near-normal systolic function as a result fo idiopathic, amyloidosis, or endomyocardial fibrosis. Moreover, the prevalence is found in populations of equatorial African origin due to endomyocardial fibrosis.

Furthermore, restrictive cardiomyopathy may originate due to impaired ventricular filling and primary diastolic heart failure. Causes and conditions associated with hemochromatosis that result in an overload of iron deposits in the sarcophagi century reticulum of organs that include the myocardium. Another cause of restricted cardiomyopathy includes sarcoidosis which is a systemic disease resulting in increased granules that infiltrate the myocardium.

Diagnostic tests include: Electrocardiography that looks at the ST segments, inverted T waves in to identify absences of right bundle branch block; Echocardiography that identifies if there is any localized aneurysm or isolated right ventricular heart failure; magnetic resonance imaging looks for increased fatty deposits or infiltration of the right ventricle; Histology by obtaining biopsy for further studies of any idiopathic, or genetic heart disease. The B-type natriuretic peptide is a hormone produced by the myocardium.

The BNP significance is to regulate changes in pressure inside the myocardium. Furthermore normal levels of BNP range from less than 125 pg/mL for patients aged 0-74 years. Less than 450 pg/mL for patients aged 75-99 years. Higher levels than 450 pg/mL for patients under age 50, or higher than 900pg/ml for patients age 50 or older may indicate heart failure.

Reference

[‘A Perez-Silva’, ‘J. L. M. (2009, January 13). Tachycardia-induced cardiomyopathy. European Society of Cardiology. https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-7/Tachycardia-induced-cardiomyopathy.

Patel, J. J., & Whittaker, C. T. (2007). Tachycardia-induced heart failure. The Permanente journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057721/.

Bott- Silverman, C., & Aksum, B. (2015, November). Dilated and Restrictive Cardiomyopathies. https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/dilated-restrictive-cardiomyopathy/.

Januzzi JL, van Kimmenade R, Lainchbury J, et al. NT-proBNP Testing for Diagnosis and Short-Term Prognosis in Acute Destabilized Heart Failure: An International Pooled Analysis of 1256 Patients: The International Collaborative of NT-proBNP Study. Eur Heart J. 2006;27:330 –337. http://eurheartj.oxfordjournals.org/content/27/3/330.long

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