&
LVAD
• SECONDARY
– Disease of the myocardium of known cause/ associated
with systemic disease
CAUSES
• Infective • Connective tissue
– Viral disorders
– Bacterial – Systemic lupus
erythematosus
– Fungal
– Polyarteritis nodosa
– Protozoal
– Rheumatoid arthritis
– Metazoal – Progressive systemic sclerosis
– Spirochetal – Dermatomyositis
– Rickettsial
• Familial storage disease • Infiltrations and
– Glycogen storage disease granulomas
– Mucopolysaccharidoses – Amyloidosis
(Hurler syndrome) – Sarcoidosis
– Hemochromatosis – Malignancy
– Fabry's disease
Contd…
• Muscular dystrophy
• Toxic reactions
– Alcohol
– Radiation
– Drugs
• Peripartum heart disease
Clinical Classification of
Cardiomyopathies
• Dilated: Left and/or right ventricular enlargement
• Inotropic agents
• Nitroglycerine
• Diuretics & sodium restricted diets
• Anticoagulants
• Avoid – alcohol, Ca channel blockers, NSAIDS,
Antiarrhythmics
Treatment
– Doxorubicin(Adriamycin)
– Trastuzumab (Herceptin)
– High-dose cyclophosphamide
– Imatinib mesylate
Hypertrophic Cardiomyopathy
• Diastolic dysfunction
– LV hypertrophy
– Septal thickening
– Ground glass appearance of septum
– SAM of the mitral valve, with mitral regurgitation
– LV cavity typically is small
Treatment
• Strenuous activities should be proscribed
• β adrenergic blocking agents
• Calcium channel blockers
• Avoid
– Drugs that decrease preload (nitrates, diuretics,
morphine)
– Drugs that increase contractility (β agonists, digitalis,
dopamine)
– Alcohol
• Atrial fibrillation
– Anticoagulants
Contd…
• Surgical myotomy/myectomy of the hypertrophied
septum
• Endocarditis prophylaxis
Restrictive Cardiomyopathy
• Abnormal diastolic function
• Most common cause - Amyloidosis
– Hemochromatosis
– Glycogen deposition
– Endomyocardial fibrosis
– Sarcoidosis
– Hypereosinophilic disease
– Scleroderma
– Following mediastinal irradiation
– Neoplastic infiltration
Clinical Features
• Exercise intolerance and dyspnea
• Dependent edema, ascites, and an enlarged,
tender, and often pulsatile liver.
• Raised JVP
• Kussmaul's sign
• S3 & S4 heard
Treatment
• Aimed at diminishing heart failure
• Chronic anticoagulation
• Heterotopic procedure
LEFT VENTRICULAR ASSISTIVE
DEVICE(LVAD)
DEFINITION
•The left ventricular assistive device(LVAD) is a mechanical
pump that is implanted inside the person chest to help a
weakened heart ventricle to pump blood throughout the
body. It is implanted under the skin .
•It helps to pump blood from the left ventricle of the
HEART to rest of the body .
•A control unit and battery pack are worn outside the body
and are connected to the LVAD through the skin.
•Unlike a total artificial heart ,LVAD does not replace the
heart .
INDICATIONS OF LVAD
• Dilated Cardiomyopathy
• Transplant client who are in danger of dying before a
donor heart is available
• Heart failure does not responsive to standard
Cardiac treatments.
• Heart failure following various forms of heart surgery
• End stage heart failure
• Improvement of survival rate and better quality of life
RISK FACTORS WITH LVAD
•BLOOD CLOTS:
•BLEEDING:
•INFECTION:
•DEVICE MALFUNCTION:
• Thromboembolism
• Device malfunction
Nursing management
Decreased cardiac output related to heart failure or
dysrhythmias secondary to cardiomyopathy
• Assess BP for hypotension & respiratory rate for tachypnea
• Assess HR & rhythm for tachycardia.
• Document the rhythm strips & if dysrhythmias occur, note the
changes
• Auscultate heart for changes in heart sounds
• Monitor lung sounds for crackles and presence of coughing
• Monitor intake and output regularly
• Assess for change in mental status
Contd…
• Assess peripheral pulse for strength and quality
• Administer prescribed medications and evaluate
responses
• Encourage physical and psychological rest
• Encourage clients to eat small meals and rest
afterwards
Excess fluid volume related to decreased cardiac
output, GFR, increased aldosterone and sodium and
water retention.
• Monitor intake and output every 4 hrly
• Weigh patients daily
• Assess for the presence of peripheral edema
• Assess for jugular vein distension, hepatomegaly and
abdominal pain
• Follow low sodium diet and fluid restriction
• Auscultate breath sounds 2 hrly for the presence of
crackles and monitor for sputum production
• Administer diuretics as ordered and evaluate
effectiveness
Impaired gas exchange related to fluid in the
alveoli
• Auscultate breath sounds 2 hrly
• Encourage client to turn, cough and deep breath ;use incentive
spirometer 2 hrly
• Administer oxygen as ordered
• Assess respiratory rate and rhythm
• Assess for cyanosis 2 – 4 hrly
• Provide fowler’s position to facilitate breathing and observe for PND
• Monitor pulse oximetry
• Obtain ABG if ordered
• Administer diuretics as ordered
Angina related to decreased cardiac output and
coronary perfusion secondary to heart failure in
cardiomopathy
• Assess for the manifestations of angina
• Assess respirations, BP, & HR with each episode of chest pain
• Obtain a 12 lead ECG each time chest pain recurs
• Administer nitrates, monitor response, notify if pain does not
abate in 15 – 20 min
• Provide care in a calm environment that minimizes anxiety
• Instruct patient to avoid physical exertion if pain occurs
• Stay with patient until discomfort is relieved.
Ineffective tissue perfusion related to
decreased cardiac output
• Note color and temperature of skin 4 hrly
• Monitor peripheral pulses
• Provide a warm environment
• Encourage active range of motion exercises
• Monitor urine output
• Protect skin from trauma
Risk of sudden cardiac death related to profound
reduction in cardiac output and dysrhythmias
secondary to HCM