Hypertrophic Cardiomyopathy: Management and Care (Nursing)

00:00 So the kinds of things we do when you recognize these cues, when you put all these things together that we've talked about previously, and you see and you get report on this type of patient, you're thinking, "Wow, this seems unusual.

00:14 I heard an odd heart sound. I listened to this patient." You're going to recommend to the physician, "Hey, I assess this. This is what I heard." They're going to ask you to get a 12 lead.

00:24 And if you're in an ER, protocol would probably cover that.

00:27 You're thinking, "Oh, wow, I've got this weird heart tone.

00:31 I'm going to follow up with a physician. We get an ECG.

00:33 Now I see some really weird things going on in there ECG." What's going to be the next step? Right, echocardiogram.

00:42 And then it could progress from there to a heart cath.

00:44 But what you're looking at as a nurse is, did you pick up those initial cues? Did you recognize the heart tones? Did you see on the ECG? Did you see the changes? Did you know to alert the healthcare provider the nurse practitioner, the PA, the physician that, hey, this is a sign that something isn't right.

01:04 And we need to follow up to make sure the patient is safe.

01:08 The goals of what we're trying to do or accomplish with someone with hypertrophic cardiomyopathy is we want to reduce their symptoms.

01:15 They're miserable. They're short of breath. They don't have energy.

01:19 We want to help reduce those symptoms.

01:21 If a patient has progressed to this point, where the wall in their left ventricles becomes so thick, it's making it difficult for blood to exit from that left ventricle through the aorta into the rest of the body.

01:35 Sometimes they have to take some pretty significant measures to reduce the size of that obstruction.

01:41 So they're going to make it bigger, or make sure that the blood is able to flow more easily out of that left ventricle.

01:49 That can be a pretty intense procedure but it can make a huge difference in a patient's quality of life.

01:56 Now, as you go on further, in the treatment of this hypertrophic cardiomyopathy, there's lots of options you can have and you can try.

02:05 So with the asymptomatic cases, they just really kind of keep an eye on them.

02:09 They do routine follow up, they keep doing repeat ECGs, for obvious reason, and they are recommended to avoid strenuous exercise.

02:18 This would be an example of a student athlete who had not be cleared to safely participate in organized sports.

02:25 Okay, so if they're asymptomatic, but this is identified as hypertrophic cardiomyopathy.

02:30 They will not be proved or clear to play sports safely.

02:35 Now, it's all types of medications.

02:37 So, it kind of depends on what is unique about this patient.

02:40 So, if they have heart failure symptoms without the left ventricle being so thick, that is decreasing the outflow, right? We can look at maybe beta-blockers.

02:50 This isn't necessarily the treatment of choice.

02:53 We can also consider calcium channel blockers.

02:56 Now, if the patient has severe symptoms, if this doesn't do it, then we also can look at diuretics.

03:02 If we have the signed any signs and symptoms of fluid overload.

03:05 so we can keep them routinely on, right, if they don't have that outflow obstruction, we can keep them routinely on beta-blockers or ACE inhibitors.

03:15 But if they're getting in a period of overload, you can add something like pretty heavy duty diuretic like furosemide, to try to help deal or treat the symptoms by removing extra fluid.

03:26 Now, finally, the most severe and complex and complicated procedure both for the surgery and for the recovery is a heart transplant.

03:36 This is only for patients who are really at the end of the line.

03:41 There's nothing else that the medication can do to ease the symptoms, and this becomes an option.

03:47 Now, if the heart failure symptoms and left ventricular outflow tract obstruction, how do we treat that? So we talked about what you do if they don't have the left ventricular outflow obstruction, what do we do if they do? We use monotherapy with beta-blockers.

04:05 That means monotherapy, we would only use the beta-blockers as a first line treatment.

04:11 If the symptoms get severe and they persist, then we might add some additional medications or add like something like the calcium channel blockers.

04:20 Now, what do you want to avoid for a patient in this type of situation? You want to avoid diuretics and vasodilators.

04:28 You want to use them with care.

04:30 Only at specific points depending how the patient is evolving.

04:34 As a nurse, just getting in your practice, this is going to be something that you would consult the cardiologist about.

04:42 Okay, so we've gone through a list of medications or possibilities.

04:46 We really can tell you some will use, some will not be used and it's getting pretty detailed for what you need to know for nursing school.

04:53 But when you get into practice, I want you to look up a cardiologist and ask them these questions.

04:59 It's going to make much more sense and stick in your mind when you're actually caring for a patient who's experiencing it, and you have someone guiding you through the rationale.

05:09 So, we've talked about things that are outside of the wheelhouse of a nurse performing.

05:14 I want to talk to you about how you can actually make a difference.

05:18 Knowing the cues and things to watch for you can help the patient develop a plan to treat the symptoms.

05:24 If it requires a physician's order, obviously, you're going to collaborate with the health care provider.

05:29 But there's lots of things you can do to help improve this patient's quality of life.

05:33 So, help them develop a plan for how to treat symptoms.

05:37 Help them prevent complications.

05:39 Provide appropriate emotional support.

05:41 Remember, you don't have to be the patient's emotional support personally.

05:46 What you want to do is connect them with resources.

05:48 So they understand their disease, they understand how to treatment, and maybe they can talk to a group or support group of people who are going through the same thing.

05:57 That's an easy thing for you to do. There's lots of resources for that.

06:01 Now, you're going to have to have a very cautious, calm, and empathetic conversation about strenuous activity.

06:08 If this client is an athlete, telling them that they should no longer run or do whatever strenuous activities, what their passion is, this is not going to be a quick conversation.

06:18 So you want to give them time, consider using concepts of motivational interviewing to help them understand the risks of strenuous activity and dehydration and how they can exacerbate those severe cardiac dysrhythmias.

06:32 You want them to also take periods of rest.

06:35 If they're having chest pain, you want them to look at maybe resting, elevating their feet, anything that will help increase that venous return of blood to the heart.

06:44 Well, that wraps up this insidious form of cardiac disease.

06:49 Hypertrophic cardiomyopathy.

06:52 Remember, it's sometimes silent and only picked up on physical exam, but you can help literally save a life if you are alert and aware to the cues that can lead you to hypertrophic cardiomyopathy.