Dilated Cardiomyopathy: Assessment and Care (Nursing)

00:01 Now let's take a look at the signs and symptoms we look at when a client is diagnosed with this.

00:06 First one is heart tones.

00:08 Now, if you're in the beginning of your nursing journey, you may not have studied these yet.

00:13 When you get there, we have a great series for you on how exactly to do that.

00:18 But for now, I just want you to think about there's a systolic heart murmur.

00:22 Remember that heart is kind of mushy, it's overworked.

00:25 So, a systolic heart murmur is a sign that we need to follow up and see if there isn't some type of cardiomyopathy.

00:32 Now, you look for a systolic heart murmur and an S3 gallop.

00:36 That will make much more sense when you have a better understanding of heart tones.

00:40 But for now, keep in mind, the heart tones will be different than lub-dub, lub-dub, lub-dub.

00:49 So, in an assessment, you will assess heart tones and notice something is unusual than the normal heart tones.

00:55 Looking at the patient's abdomen, you're going to notice that they seem to have extra fluid, or edema, which is called ascites when it's in the abdomen.

01:04 Pulmonary, we talked about it, but just want to remind you that this will be crackles.

01:09 So you hear that sound over the lung fields and it will develop in the back and bases first.

01:15 And know when you have crackles, you have impacted or decrease the efficiency of the lungs being able to exchange CO2 and O2.

01:25 Let's talk about some of this specific lab work that goes along with cardiomyopathy to assess if or how severe the heart failure is.

01:35 Now, BNP is a very specific test that tells us there is damage to the heart tissue.

01:40 Elevated troponin are another test.

01:42 And that's also done when we're assessing for an MI.

01:45 Remember, that's also damage to the heart tissue.

01:48 Now, the third one is CK-MB.

01:51 And it's just not as specific as troponins.

01:53 We use it for a long time but then once troponins were developed, it's a much more accurate marker.

02:00 But any one or all three of these tests could be drawn to assess where the client is in dealing with fluid volume overload.

02:09 Then here's a chest X-ray.

02:10 You will not be expected to read a chest X-ray.

02:13 But this was so cool. We just wanted to show you.

02:16 Okay, so this is a typical chest X-ray. I've already told you that.

02:19 But what we want to show you is the difference between where a normal heart would look like a chest X-ray.

02:25 And then you see the outside pink lines would show you an enlarged heart.

02:31 So, we use this X-ray to show you that you can actually see changes to the heart in dilated cardiomyopathy on a chest X-ray.

02:40 Now, on the other side, there's a pleural effusion.

02:43 That means you've got even more fluid building up in the lungs.

02:46 Again, you would not have to diagnosis on a nursing school exam, or on your NCLEX.

02:52 But we thought it was pretty cool.

02:54 And we wanted to show you during this series.

02:57 Now, when you look at an ECG or electrocardiography, you're going to see sinus tachycardia most often.

03:05 That's most common what you will see.

03:07 Remember that hearts on efficient, so it's just trying to be faster.

03:10 So we can keep up with what the body needs.

03:12 This is what a strip would look like.

03:15 If you don't know how to interpret these, we have a whole video series on how to do it.

03:19 But if you haven't had experience with this sinus tachycardia means the SA node is still firing.

03:26 It's in within a realm of normal. It's just too fast.

03:29 And that's why it's called sinus tachycardia.

03:33 Now, we can also have ventricular arrhythmias and these are much more serious.

03:38 Sinus tachycardia is not that big a deal depending on how tired the patient is.

03:42 But ventricular arrhythmias are certainly more life threatening.

03:48 So, we've talked about two types of arrhythmias that you would see.

03:52 Sinus tachycardia, which is not so concerning.

03:55 Ventricular dysrhythmias very concerning.

03:59 Now, this one's in the middle. It's called atrial fibrillation.

04:03 Now, how your heart works is you'd have atrium ventricle, atrium ventricle, atrium ventricle, atrium ventricle, right? When they work together, it's a beautiful thing.

04:12 The valves work right. The blood flows through correctly.

04:16 That's what we want.

04:17 But you'll notice on this strip, you have those tall spikes. Those tall QRS is.

04:22 But in the middle, you got like this. It looks like trash, right? That's because atriums kind of doing this.

04:29 And so instead of a nice contraction, you're getting really just kind of this fibrillating and it's not efficient.

04:38 You end up dropping at least 20% of your cardiac output in atrial fibrillation.

04:44 Now, this is pretty common to people with this type of failure.

04:47 Keep in mind, blood that hangs out together.

04:51 So if someone in atrial fibrillation, they're not able to completely empty, that atrium.

04:56 You're going to end up blood that stays together ends up clotting together, and that becomes a real problem.

05:03 Now, a patient may also be sent to MRI.

05:05 You saw, we could see on a chest X-ray, you get much more detail on an MRI.

05:10 So that may be part of the diagnosis process.

05:14 Let's keep moving and talking about some of the treatments that we can use because the goal of treatment is to reduce the symptoms.

05:21 So what are the symptoms? They have edema, they feel short of breath.

05:25 Some of them can't lay down if they're in bed in a failure.

05:28 So what are the things that we can do to help them with that? Well, if we want to improve the systolic function, and ACE inhibitor is one option.

05:37 Remember, systolic is that left ventricle pushing blood out through the rest of the heart.

05:44 You give them an ACE inhibitor.

05:47 There's going to be less vasoconstriction in the body.

05:50 With less vasoconstriction in the body, it's going to be easier job for the left ventricle to push blood throughout the body because the vessels will be more dilated than they wouldn't be if the patient wasn't taking the ACE inhibitor.

06:02 So first symptom we're talking about is we want to improve systolic function, which should help us with parallel edema, things backing up and fluid volume in balance.

06:14 Next up are beta-blockers.

06:16 This is another group of cardiac medications, this can help increase the amount of blood, the ejection fraction, the amount of blood that the heart can pump out, because this kind of slows things down.

06:28 Kind of organizes the heart.

06:30 And it decreases the workload so the heart can be more efficient.

06:34 So two favorite cardiac meds for cardiomyopathy.

06:38 ACE inhibitors, and notice most of them end in -pril.

06:41 And beta blockers, most of them and their generic term and in -olol.

06:47 Now that we've talked about working directly on the heart, Let's talk about diuretics.

06:53 Diuretics are going to help just pull off extra fluid.

06:56 So we use the diuretics like furosemide, which is the most potent.

07:00 We use that to treat the volume overload.

07:03 Now remember, your patients need to take that in the morning, but it can last up to like six hours.

07:09 So they do not want to take it at nighttime when they go to bed because there'll be a pain all night.

07:15 Another group is vasodilators.

07:17 That's going to dilate those vessels, something like nitroglycerin.

07:21 That's going to make the workload less for the heart.

07:23 It's going to require less oxygen.

07:25 So vasodilators, are also helpful.

07:28 Now, Vitamin K antagonist.

07:30 This is particularly useful for those in atrial fibrillation.

07:33 See something like Warfarin is going to help prevent or minimize the risk of clots forming.

07:39 Now, can you remember why someone with dilated cardiomyopathy would have an increased risk for clots? Did you get it? Because if they're in atrial fib, that atrium cannot compress an empty completely, so you end up with an increased risk for clots.

07:58 That's why you would want somebody on a Vitamin K antagonist, like warfarin, so they minimize your risk of developing those clots.

08:06 Now, you can also use devices, something like a pacemaker or an implanted cardioverter defibrillator.

08:13 My mom has one that does both.

08:15 So she doesn't have congestive heart failure but she has some real challenges with her valves.

08:20 And this was kind of one less unusual placement for it, but it's done wonders for her. So, she has it in.

08:27 The pacemakers, what really gave her more energy.

08:30 The cardioverter defibrillator.

08:32 Thankfully, we haven't had to use that at this point.

08:34 But a pacemaker is just going to keep firing on that heart, helping it stay steady and consistent.

08:40 So this is not like the early part of treatment to put something in.

08:44 But devices like these, a pacemaker or defibrillator can be very helpful in the right patients.

08:50 Now, end of the road is a heart transplant.

08:53 Very complex, very expensive, and the patient will have to be on very specific medications for the rest of their life, so they don't reject the transplant.

09:03 So that is not something that you see commonly occur for all those reasons.

09:07 It's very complex. So give your brain a break.

09:10 Pause, look away from your notes and see how many of these types of treatments you can remember.

09:18 So what can we do as a nurse when you're educating a patient about how to minimize their risks and their symptoms? Well, I'm going to give you this an acronym that has five letters.

09:29 The first one is E, for exercise.

09:32 Now, if they're decompensating, and they can't keep you up.

09:35 They shouldn't just push through it.

09:37 But everyone benefits from exercise at their appropriate level.

09:40 They can seek advice from their physician or nurse practitioner, their PA that will recommend how hard they should exercise and what they should do.

09:49 But exercise helps absolutely everyone.

09:52 Now the next two letters are R for restriction.

09:56 You want to restrict salt because wherever salt goes a lot of follows.

10:02 So it's recommended that the client stick to 2 grams of sodium per day in their diet.

10:06 The other restriction is fluids.

10:09 If the patient is really in failure, if they have significant cardiomyopathy, we want to make sure that they keep a very close watch on how much fluid they take in in a day.

10:21 Now, the healthcare team will make a recommendation to them based on how many ounces or milliliters they feel that patient can take a day.

10:28 Now, M is minimized. It would be fantastic if they could quit smoking, and minimize alcohol consumption.

10:37 But sometimes that's not realistic.

10:39 So meet patients where they are.

10:40 Helped them take the next step to health, but minimizing smoking and alcohol consumption will significantly benefit them.

10:48 Remember, these are toxins that can cause further damage to the heart.

10:52 And finally, avoid illicit drug use, right? Completely. We didn't talk about minimize, or we really recommend that you don't do that at all.

11:02 So let's kind of ERRMA. Go ahead and pause the video.

11:06 See if you can remember which each one of these letters stands for as a recommendation for you to educate your patients about or in dilated cardiomyopathy.

11:15 So that wraps up your introduction and overview of the most common form of heart failure, dilated cardiomyopathy.

11:24 So hang with us for the rest of this series, and I'll see you in the next video.