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Topic: NSG 430: Critical Care Nursing
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?
Please respond to my peer discussion post based on the topic and website information provided above.
Hypertrophic cardiomyopathy abnormal gene that is most often inherited that affects the left ventricle, causing the ventricle to contract harder and become thicker than normal, and becomes stiff (AHA, 2021). With a thicker than normal ventricle, the amount of blood is reduced with each heartbeat (AHA, 2021). There are two types of hypertrophic cardiomyopathy: Obstructive and Nonobstructive (AHA, 2021). Symptoms are not seen in everyone. Signs and symptoms include Chest pain with physical exertion, fatigue, dizziness, and syncope (AHA, 2021). Those with hypertrophic cardiomyopathy are at higher risk for developing atrial fibrillation (AHA, 2021). Diagnosis is can be done by echocardiogram.
Restrictive cardiomyopathy tends to affect older adults. The heart’s ventricles become rigid because of abnormal scarring of the tissue (AHA, 2021). This can lead to problems such as heart failure or arrhythmias (AHA, 2021). Other Names for restrictive cardiomyopathy are idiopathic restrictive and infiltrative cardiomyopathy (AHA, 2021). Diseases such as hemochromatosis, sarcoidosis, amyloidosis, and some cancer treatments, such as radiation and chemotherapy (AHA, 2021).
What type of patient it might affect? Cardiomyopathy can affect all ages (Mayo Clinic, 2020). Certain age groups are more likely to have certain types of cardiomyopathy (Mayo Clinic, 2020). Individuals with a family history of cardiomyopathy; coronary artery disease; diabetes; obesity; and alcohol abuse and drug abuse are affected (Mayo Clinic, 2020).
What is the difference? In dilated cardiomyopathy, the left ventricle becomes enlarged and can’t effectively pump blood out of the heart (Mayo Clinic, 2020). This type can affect people of all ages, but often in middle-aged people. It is also more likely to affect men (Mayo Clinic, 2020). Hypertrophic cardiomyopathy involves abnormal thickening of your heart muscle affecting the muscle of your heart’s left ventricle (Mayo Clinic, 2020). Hypertrophic cardiomyopathy can develop at any age. It is more severe if it becomes apparent during childhood (Mayo Clinic, 2020). Restrictive cardiomyopathy is the least common. The heart muscle becomes rigid and less elastic, so it can’t expand and fill with blood between heartbeats (Mayo Clinic, 2020). Restrictive cardiomyopathy occurs at any age, but it most often affects older people (Mayo Clinic, 2020).
How would you as a nurse change your plan of treatment, tests, lab, medication, etc.? Plan of care includes lifestyle changes. As a nurse, I would prescribe anticoagulants, antiplatelets, ACE Inhibitors, Beta Blockers, Calcium Channel Blockers, Diuretics, and Vasodilators (Mayo Clinic, 2020). A plan of care would also involve the patient quitting smoking, lose weight, exercise, eliminate or minimize alcohol, eat a healthy diet, and reduce salt intake (Mayo Clinic, 2020).
What changes might you see in their EKG tracing?
Multiple findings such as T-wave inversion, ST-segment depression, and pathologic Q waves are present in patients with cardiomyopathy (Pelto et al., 2013). T- wave is ventricular repolarization. Changes in the T wave indicate an electrolyte imbalance, or myocardial ischemia or injury (Sole et al., 2017, p. 99). ST-segment is usually isoelectric or flat. A patient with ST-segment depression is where the ST-segment is falling below the baseline. A displacement in the ST segment can indicate myocardial ischemia or injury (Sole et al., 2017, p. 100). A pathological Q wave has a width of 0.04 seconds and a depth that is greater than one-fourth of the R-wave amplitude (Sole et al., 2017, p. 99). According to Sole et al., Pathological Q waves are found on ECGs of individuals who have had myocardial infarctions, and they represent myocardial muscle death (Sole et al., 2017, p. 99). The changes on EKG for T-wave suggests ventricular hypertrophy, P-wave abnormalities suggest of left atrial enlargement, and Q waves suggest hypertrophied septal depolarization (Owens & Reza, 2020). The EKG is not specific to Hypertrophic Cardiomyopathy (Owens & Reza, 2020).
What is EF or ejection fraction? Ejection fraction is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. An ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is pushed out with each heartbeat. This indication of how well your heart is pumping out blood can help to diagnose and track heart failure (heart.org, 2021).
How is this affected by their disease process? An ejection fraction measurement higher than 75 percent may indicate a heart condition such as hypertrophic cardiomyopathy. An ejection fraction measurement under 40 percent may be evidence of heart failure or cardiomyopathy. (heart.org, 2021).
What is BNP (B-type natriuretic peptide) what are the significance and the level? The ventricular myocardium secretes BNP in response to stretch from the heart chambers. BNP causes vasodilation and diuresis and inhibit the sympathetic response and renin-angiotensin-aldosterone system in an attempt to decrease circulating blood volume and decrease stress on the myocardium (Sole et al., 2017, p.134). BNP is a cardiac hormone that is secreted by ventricular myocytes a response to wall stretch (Sole et al., 2017, p.134). A good marker for differentiating between pulmonary and cardiac causes of dyspnea. Plasma concentrations of BMP reflect the severity of heart failure. As heart failure is treated the BNP is used to assess the response to therapies. The normal BNP concentration is less than 100. Sole et al., 2017, p. 326).
AHA. (2021). Ejection Fraction Heart Failure Measurement. www.heart.org. https://www.heart.org/en/health-topics/heart-failure/diagnosing-heart-failure/ejection-fraction-heart-failure-measurement.
AHA. (2021). Hypertrophic Cardiomyopathy (HCM). www.heart.org. https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/hypertrophic-cardiomyopathy.
Mayo Clinic. (2020, August 8). Cardiomyopathy. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cardiomyopathy/symptoms-causes/syc-20370709.
Owens, A., & Reza, N. (2020). Diagnosis of Hypertrophic Cardiomyopathy: What Every Cardiologist Needs to Know. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2020/02/25/06/34/diagnosis-of-hypertrophic-cardiomyopathy.
Pelto, H., Owens, D., & Drezner, J. (2013). Electrocardiographic Findings Suggestive of Cardiomyopathy. Current Sports Medicine Reports, 12(2), 77–85. https://doi.org/10.1249/jsr.0b013e3182874abb
Sole, M. L., Moseley, M. J., & Klein, D. G. (2017). Introduction to critical care nursing. Elsevier.