Management of Heart Disease

Management of Cardiomyopathy

Cardiomyopathy (heart muscle disease), is the deterioration of the function of the myocardium (i.e., the actual heart muscle) for any reason. It is associated with cardiac dysfunction.

It is classified according to the structural and functional abnormalities of the heart muscle:

  • Dilated cardiomyopathy (DCM)
  • Hypertrophic cardiomyopathy (HCM),
  • Restrictive or constrictive cardiomyopathy (RCM)
  • Arrhythmogenic right ventricular cardiomyopathy (ARVC)
  • Unclassified cardiomyopathy

Cardiomyopathy may lead to severe heart failure, dysrhythmias, and death.

Risk Factors

Some people seek help when they first notice chest pain, shortness of breath and palpitations. Patients should act at the very first sign that they might be at risk: a family history of heart disease. Other key risk factors for heart disease include:

  • Smoking
  • High cholesterol and blood pressure
  • Diabetes
  • Sedentary lifestyle

Pathophysiology
The pathophysiology of all cardiomyopathies is a series of events that culminate in impaired cardiac output. Decreased stroke volume stimulates the sympathetic nervous system and the renin—angiotensin—aldosterone response, resulting in increased systemic vascular resistance and increased sodium and fluid retention, which places an increased workload on the heart. These alterations can lead to heart failure.
Dilated Cardiomyopathy (DCM) (most common)

DCM is characterized by left ventricle cavity enlargement and systolic failure. This is due to dilation of the ventricles without simultaneous hypertrophy (i.e., increased muscle wall thickness). The ventricles have elevated systolic and diastolic volumes but a decreased ejection fraction (EF).

 Causes of DCM

There is no specific cause that has been identified to cause DCM, but the following factors have been associated with its development;

  • Pregnancy
  • Heavy alcohol intake
  • Viral infection (e.g., influenza)
  • Thyrotoxicosis
  • Diabetes Melitus
  • Nutritional deficiencies
  • Chemotherapeutic agents.

When the causative factor cannot be identified, the diagnosis is idiopathic DCM. Idiopathic DCM accounts for approximately 25% of all heart failure cases. The result is poor systolic function. The structural changes decrease the amount of blood ejected from the ventricle with systole, increasing the amount of blood remaining in the ventricle after contraction. Less blood is then able to enter the ventricle during diastole, increasing end-diastolic pressure and eventually increasing pulmonary and systemic venous pressures.

Altered valve function, usually regurgitation can result from an enlarged stretched ventricle.

Poor blood flow through the ventricle may also cause ventricular r atrial thrombi, which may embolize to other locations in the body.

Clinical Manifestations

Patient presents with signs and symptoms of;

  • Congestive heart failure
  • Fatigue
  • Cough
  • Dyspnea
  • Orthopnea
  • Palpitations and orthopnea
  • Edema
  • Weak peripheral pulses
  • Pallor
  • Hepatomegaly
  • Jugular venous distension

Hypertrophic Cardiomyopathy (HCM)
In HCM, the heart muscle asymmetrically increases in size and mass, especially along the septum without ventricular dilation. The increased thickness of the heart muscle reduces the size of the ventricular cavities and causes the ventricles to take a longer time to relax after systole.

The four main characteristics are;

  • Massive ventricular hypertrophy
  • Rapid forceful of contraction of the LV
  • Impaired relaxation (which inhibits adequate filling of the ventricles during diastole)
  • Obstruction of aortic outflow (This results in decreased cardiac output especially on exertion).

Restrictive Cardiomyopathy
Restrictive cardiomyopathy (RCM) is characterized by diastolic dysfunction caused by rigid ventricular walls that impair ventricular stretch and diastolic filling Systolic function is usually normal.

General Clinical Manifestations of Cardiomyopathy

The patient may have cardiomyopathy but remain stable and without symptoms for many years. As the disease progresses, so do symptoms.

Frequently, dilated and restrictive Cardiomyopathy are first diagnosed when the patient presents with signs and symptoms of heart failure (e.g., dyspnea on exertion, fatigue).

Patients with cardiomyopathy may also report paroxysmal nocturnal dyspnea, cough (especially with exertion), and orthopnea, which may lead to a misdiagnosis of bronchitis or pneumonia.

Other symptoms include fluid retention, peripheral edema, and nausea, which is caused by poor perfusion of the gastrointestinal system.

The patient may experience chest pain, palpitations, dizziness, nausea, and syncope with exertion.

Collaborative Management

Controlling symptoms of heart failure

Limiting or restricting activity

Prohibiting alcohol intake

Pharmacotherapy

  • Antidysrhythmic agents to control dysrhythmias
  • B-blockers to decrease outflow obstruction during exercise
  • Calcium antagonists to decrease outflow obstruction
  • Anticoagulants to prevent embolus formation
  • Vasodilators to decrease cardiac workload

Nutritional Management

  • Choose foods that are low in saturated and trans fats.
  • Healthy choices include lean meats, poultry without skin, non-fried fish, beans as well as fat-free or low-fat milk and milk products.
  • Choose and prepare foods with little salt (sodium).
  • Too much salt can raise your risk of high blood pressure.

IT WON’T HURT TO;

  • Do regular aerobic exercise
  • Stop smoking and limit alcohol. 
  • Get enough sleep
  • Know your blood pressure, cholesterol and blood sugar levels
  • Discuss your risk with your doctor

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