 Welcome to nursing school explained in this video on cardiomyopathy. Now keep in mind that we can always kind of dissect the actual word and so if we look at this cardio meaning heart, myo meaning muscle and then pathy disease. So this is a disease of the heart muscle. And risk factors to developing cardiomyopathy are all those chronic things that are caused by poor lifestyle such as diabetes, hypertension, hyperepidemia, obesity, but also coronary artery disease, bowel disorders, myocarditis, so infectious diseases of the myocardial, but that can also be genetic causes. And then cardiotoxic drugs can also lead to cardiomyopathy and those are mostly things like alcohol, cocaine or methamphetamines. Anything that speeds up the heart or chemotherapy drugs can also be toxic to the heart. So in terms of pathophysiology, the heart muscle becomes weak, it becomes enlarged, sick or rigid, which then leads to decreased cardiac output, decreased ejection fraction and eventually signs and symptoms of heart failure. There are three different types of cardiomyopathy, dilated, hypertrophic and restrictive and they are listed here in the order that they occur. So dilated cardiomyopathy is the most common cause of cardiomyopathy. It is mostly caused by myocarditis or alcoholism. And what happens here is that the left ventricle dilates and the chamber enlarges which then decreases the contractility because that chamber is not able to contract as effectively which leads to a decrease in cardiac output as well as ejection fraction and then eventually signs and symptoms of heart failure. So here in the drawing we have this very thin ventricular wall which then leads to this left ventricle to become enlarged but also the chamber itself becomes bigger and as the chamber becomes bigger more blood is allowed in but the heart muscle is weak so it can't contract leading to this decreased contractility. Signs and symptoms of dilated cardiomyopathy are fatigue, dyspnea on exertion, paroxysmal and nocturnal dyspnea as well as orthopnea. The patient might be complaining of palpitations. They might have a dry cough as the heart failure is starting to develop and fluid is starting to back up into their lungs. They might have abdominal distention meaning that maybe they have hepatospatomegaly that's developing. We might hear murmurs an S3 and an S4 as this heart muscle is becoming weaker and thinner and then it might lead to this arrhythmias that we can detect on an EKG and basically all those other signs and symptoms of heart failure like crackles in the lungs peripheral edema, JVD, hepatospinomegaly I already mentioned so all those things. In addition because now we do have this enlarged chamber here more blood has a chance to pull when then as it gets shaken around just like an atrial fibrillation this pulled blood has an increased risk of developing into clots and so we want to make sure that the patient doesn't have a stroke or pulmonary embolus from this dilated cardiomyopathy. Now the second cause is hypertrophic cardiomyopathy and this basically means that either the left ventricle or the septum enlarges and so now that chamber rather than being big as we seen over here becomes small as that left ventricle or the septum becomes thickened so now we have this enlarged left ventricular hypertrophy and now there's this outflow obstruction because we just can't pull or feel this left ventricle with enough blood and therefore the cardiac output again is reduced leading to all these signs and symptoms that we already discussed. Of note here is that men are more likely than women to develop hypertrophic cardiomyopathy and unfortunately it is the leading cause of sudden cardiac death in athletes because many times it goes undetected because the patient might have some underlying issue that they never get checked out for and then they exert themselves in physical activities and then they might have a sudden cardiac arrest and so signs and symptoms here are again this near on exertion because of this decreased cardiac output but this might also develop quite quickly and the patient might not have any symptoms and then suddenly die during activity but the patient might also have signs and symptoms of angina so decreased blood being pumped out to the heart they might have syncope or presyncope and again this rythm is as the heart is not perfusing itself really well. Now the third type is the most rare the least common which is restrictive cardiomyopathy and so now the ventricular muscles become stiff they just kind of lose their ability to contract which leads to impaired filling because the the muscle can't basically just dilate dilate it let that blood passively fill in fill in during the ventricular filling and um there is fibrosis and scarring of that hard muscle and again we're leading to heart failure here so because of this decreased elasticity of that hard muscle we imagine that rubber band um that I describe in one of the other videos that kind of allows for the heart muscle to contract and expand to produce that cardiac output but now if that rubber band has become less elastic we're not going to be able to produce the cardiac output with the pliable and more elastic cardiac muscle cells. Signs and symptoms of restrictive cardiomyopathy are again fatigued in dyspnea on exertion as well as angina syncope palpitations and then leading to signs and symptoms of heart failure. So as you can see although the pathophysiology the underlying pathophysiology might be a little bit different but eventually all three of these types of cardiomyopathy will lead to heart failure so signs and symptoms of heart failure are very important to recognize here. Now the other diagnostic tests that we might want to do whether we might see in patients with cardiomyopathy are chest x-ray so we can see the if the heart muscle is enlarged and also if we have signs and symptoms of pulmonary infiltration from the back and above the fluid here and echocardiogram to check out the patient's heart chambers as well as the valves and EKG to detect any dysrhythmias. They might do cardiac MRI to evaluate the structures in more detail. A BNP certainly is the cardiac marker that we use in the evaluation of heart failure and the patient might need an endomyocardial biopsy if myocarditis or genetic underlying disorders are suspected or they might need a cardiac catheterization to evaluate the ability of the heart to fill and the volumes that the chambers actually fill with to evaluate the degree of the cardiomyopathy. Treatment so because we have all these underlying signs and symptoms of heart failure we want to control these signs and symptoms with ACE inhibitors, ARBs or ARNIs which is the latest in the treatment of heart failure. Beta blockers may be used as well as calcium channel blockers to control the rates as well as the contractility of the heart. The patient might need diuretics if their fluid volume overloaded or nitrates if they have symptoms of angina and then certainly because we have all these underlying causes, diabetes, hypertension, hyperlipidemia the patient will be on a statin and anticoagulants to prevent these clots that can form. Another treatment is called an ALBAD which stands for left ventricular assist device which is an implantable device that will basically assist the left ventricle to generate that cardiac output and it's a very specialized device that takes specialized training for nurses to care for patients with ALBADs. Certainly if the heart muscle is so diseased that the ejection fraction is very low usually less than 30 or 20 percent the patient might be a candidate for a heart transplant or demanding the pacemaker with an implanted cardioverter and defibrillator if their ejection fraction is less than 30 percent because now they are at a high risk for developing dysrhythmias and if we don't have a pacemaker or ICD available then the patient might go into a lethal arrhythmia and suddenly die. Now other lifestyle issues are decreased sodium in the diet because we know that with heart failure patients tend to retain a lot of fluid and then moderate exercise is recommended but patients with cardiomyopathy should avoid strenuous activity because this disney on exertion might kind of put them over the threshold and then cause a dysrhythmia or other pulmonary edema and other signs and symptoms. Now as for complications cardiomyopathy the weaker the heart gets the less the ejection fraction becomes the more likely the patient is to develop dysrhythmias and this can be anything such as atrial fibrillation or even ventricular tachycardia and ventricular fibrillation and again the patient is at high risk for clotting which could lead to strokes and pulmonary emboli. So thank you for watching this video on cardiomyopathy and the three different types. Please also watch the other videos that pertain to all of these cardiac topics that you can find in my cardiac or critical care playlist. See you soon here on nursing school explain thanks for watching