Hypertrophic Cardiomyopathy

SIGNS & SYMPTOMS
1. Subjective
  1. Exertional chest pains
    1. Light-headedness
      1. Syncope
        Palpitations
        Dyspnea (Argulian, Sherrid, & Messerli, 2016)
2. Objective
  1. Additional heart sounds
    1. Murmur
      1. Prominent apical pulse
        Brisk/bifid carotid pulse (Argulian, Sherrid, & Messerli, 2016)
  2. Assessments
    1. Diagnostic Tests: Electrocardiogram
      1. P wave abnormalities
        Repolarization changes
        Axis deviations (Argulian, Sherrid, & Messerli, 2016)
        T waves diffuse large and inverted if cardiac apex abnormally thick
        Large “dagger like” septal Q-waves (Lome, 2016)
TREATMENTS
1. Dependent on symptoms
  1. Arrhythmias (Argulian, et al., 2016)
    1. Anticoagulation
      1. Rhythm Control
        Cadioversion
        Antirhythmic agents
  2. Left Ventricular Outflow Obstruction
    1. Beta blockers: reduced inotropy and longer ventricular filling times reduce obstructive symptoms (Argulian, et al., 2016).
      1. Disopyramide can be used in combination with beta blockers and should be considered before any invasive therapies (Argulian, et al., 2016).
        Surgery and catheter-based treatment of outflow obstruction, associated with low complications and successful relief of obstruction (Argulian, et al., 2016).
        Surgical Myectomy for young patients with low rsk
        Catheter-based care for older patient with higher risks and comorbidities
  3. Non-obstructive (Argulian, et al., 2016)
    1. Beta Blockers
    2. Calcium Channel Blockers
PATHOPHYSIOLOGY
1. First signs recognized in the pathophysiology of hypertrophic cardiomyopathy are pathogenic mutations in cardiac sarcomere
  1. Mitral valve apparatus abnormalities
    1. Diagnosis confirmed via genetic testing
      1. Abnormal loading conditions present causing left ventricle to require more effort. (HTN, aortic stenosis)
        Left ventricle hypertrophy can lead to obstruction of the left ventricle outflow which can result in atrial arrhythmias, embolic phenomena, and HF (Argulian, Sherrid, & Messerli, 2016
        May lead to sudden cardiac death in young healthy individuals (Jacoby, Depasquale, & McKenna, 2013).
NURSING IMPLICATIONS
1. Must be able to interpret ECG reading (Palmer, 2013).
  1. Advocate for other tests if HCM is suspected
2. Family History
  1. ECG
  2. Multiple sudden deaths in the family
    1. Review postmortem reports if possible
    2. Advocate for family screening
  3. Assessing Heart Sounds
    1. Harsh systolic crescendo >> decrescendo murmur at the left sternal border
      1. Diminished with squatting and increases when standing
CAUSES
1. Common inherited type of cardiomyopathy. (Jacoby, Depasquale, & McKenna, 2013)
  1. Described as thickening of left ventricle with no apparent cause. (Argulian, Sherrid, & Messerli, 2016)
    1. General experience is that late development or progression of hypertrophy is uncommon, with most cases of hypertrophy developing during adolescence and early adulthood (Argulian, et al., 2016).
      1. Disease is attributed to many sarcomere gene mutations (Argulian, et al., 2016)
        "Autosomal dominant disease is predominant, with most sporadic and alternate inheritance patterns (X-linked, mitochondrial) representing phenocopies. Disease penetrance is incomplete and expression is variable, making the familial nature of this disease occasionally challenging to appreciate" Argulian, et al., 2016).
LIFESTYLE CHANGES
1. Decreased physical activity
  1. Children are forced to quit sports or greatly decrease participation
  2. May hinder future career plans
2. Social Changes
  1. Some children have fears of informing their peers of their condition, because they might be treated differently
  2. Children may be separated from social groups
3. Restricting alcohol consumption (Bratt, et al., 2012)
4. Quit smoking
5. Losing weight (Wexler et al., 2009)
  1. moderate excersice
    1. low-sodium diet

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Hypertrophic Cardiomyopathy

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	Erstellt von Samantha Salonga vor mehr als 7 Jahre