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Dilated cardiomyopathy is a

disease of the heart muscle,


usually starting in your heart's
main pumping chamber, the left
ventricle.
A common cause of heart failure, the
heart's inability to supply the body with
enough blood can also contribute to
irregular heartbeats, arrhythmias, blood
clots and sudden death.
Acute Hepatic Congestion is an acute
consequence of right heart failure.
increased central venous pressure may
cause elevations of liver enzymes and
both direct and indirect serum bilirubin.
Dilated cardiomyopathy is more common
in blacks than in whites and in males than
in females. It can occur in children, but
usually doesnt occur until adulthood,
between the ages of 20 and 60.
CAUSES
High blood pressure or hypertension
Coronary artery disease
Damage to the heart muscle from a heart
attack
Family history of dilated cardiomyopathy
Alcoholism
Certain chemotherapy drugs and radiation
for treating cancer
Cocaine use
Viral or bacterial infections of the heart muscle
Metabolic disorders, such as thyroid disease or diabetes
Diseases that can damage the heart, including
hemochromatosis and sarcoidosis
Obesity
Nutritional deficiencies of essential vitamins and minerals,
such as selenium
Inflammation of heart muscle from immune system
disorders, such as lupus
Metals and other toxic compounds, such as lead, mercury
and arsenic
Neuromuscular disorders, such as muscular dystrophy
HIV infection
SIGNS AND SYMPTOMS
Heart failure symptoms including shortness of
breath, dyspnea, orthopnea, distended jugular
vein and fatigue
Swelling of the lower extremities
Weight gain or edema
Fainting which is caused by conditions such as
irregular heart rhythms and abnormal responses
of the blood vessels during exercise
Palpitations or fluttering in the chest due to
abnormal heart rhythms.
Dizziness or lightheadedness
Blood clots can form in the dilated left
ventricle as a result of pooling of the
blood;
Chest pain or angina
Sudden death
Medical management is directed toward
identifying and managing possible
underlying or precipitating causes;
correcting the heart failure with
medications, a low-sodium diet, and an
exercise/rest regimen; and controlling
dysrhythmias with antiarrhythmic
medications and possibly with an
implanted electronic device, such as an
implantable cardioverter defibrillator.
Pharmacologic interventions include the
following: Angiotensin-converting enzyme
(ACE) inhibitors, angiotensin II receptor
blockers, beta-blockers, aldosterone
antagonists, cardiac glycosides, diuretics,
vasodilators, antiarrhythmics and
anticoagulants.
The nursing care of the patient with dilated
cardiomyopathy focuses on improving right
and left heart function, reducing cardiac
filling pressures with diuretics,
vasodilators, and restriction of dietary
sodium, oral and IV fluids, maintaining
optimum oxygenation, preventing
complications associated with either the
disease or treatment, and assisting the
patient in preventing complications.
PATHO
NCP
Nursing Diagnosis No. 1: Decreased
cardiac output related to altered
myocardial contractility
Nursing Diagnosis No. 2: Ineffective
breathing pattern related to decreased
lung expansion and pulmonary congestion
secondary to dilated cardiomyopathy.
Nursing Diagnosis No. 3: Fluid volume
excess related to water retention as
evidenced by bipedal edema.
Nursing Diagnosis No. 4: Activity
intolerance related to imbalance between
oxygen supply and demand as evidenced
by dyspnea.
Nursing Diagnosis No. 5: Impaired skin
integrity related to inflammatory process
as evidenced presence of erythematous
and scaly patches on skin.
CHAP 5

The study shows that the factors that have


contributed to the clients illness come
mainly from poor lifestyle choices
regarding alcohol intake and smoking.
The researchers focused on improving
and maintaining cardiac output, increasing
activity tolerance, adhering to self-care
program including lifestyle changes such
as abstinence from cigarette and alcohol
use.
During a symptomatic episode, rest is indicated.
Many patients with Dilated Cardiomyopathy find
that sitting up with their legs down is more
comfortable than lying down in a bed. This
`position is helpful in pooling venous blood in the
periphery and reducing preload.
Assessing the patients oxygen saturation at rest
and during activity may assist with determining a
need for supplemental oxygen. Oxygen is
usually administered through a nasal cannula
when indicated.
HEALTH TEACHING
Cardiac rehabilitation
Nutrition
Lifestyle changes
Safety
ADLs
Medications
Follow-up