Hypertrophic Cardiomyopathy: Manifestations (Nursing)

00:01 Now, we're getting back into that clinical judgment measurement model.

00:03 This will really help you when you're preparing for practice and for your exams.

00:08 Remember, it ties down to most importantly, what cues should you be looking for? And do you know how to analyze them and put them together and prioritize your hypothesis, and on through the rest of those six steps.

00:20 But let's go back and take a look at what are the cues, what are the things that you should be on the lookout for? This is one of the things that scares me the most about hypertrophic cardiomyopathy.

00:35 This is what happens to the athletes.

00:37 Remember, we refer to that earlier.

00:40 But this is the number one cause of sudden deaths and cardiac arrest in athletes.

00:45 They're asymptomatic until they have the event.

00:49 So keep that in mind. This one is like insidious.

00:51 You may not even know that it's there.

00:54 Again, it's why the physicals are so important.

00:57 Now, I want to talk about symptoms that your patient may display.

01:01 One of those is chest pain. But let's break that down as to why.

01:05 As this wall is thickening, which is the definition of hypertrophic cardiomyopathy, it's unable to get oxygen down to the deepest portion of the myocardium, the muscle tissue itself, When the muscle cannot get oxygen, that's going to lead to ischemia and oftentimes pain.

01:24 That's why someone with this hypertrophic cardiomyopathy can have angina pectoris or chest pain.

01:30 Now you mess with the structure of the heart like that.

01:33 They can also have palpitations and dysrhythmias, too.

01:36 So when you're thinking about those with symptoms, that's why they have chest pain, that wall is getting thicker, and you can't get the oxygen into the deepest parts of that wall.

01:46 You're going to have some weird dysrhythmias, because you're actually changing the structure and function of the heart.

01:52 Now, some patients may have exertional dyspnea.

01:56 That means if they're at rest, they're kind of doing okay.

01:59 Their cardiac output volume is enough to keep up with what they need for oxygen.

02:04 But if you cause them to work a little bit to move or to exert themselves, they become very quickly short of breath, that's exertional dyspnea.

02:15 Now, that is a sign that, wow, things are not going well.

02:18 But if the patient has dyspnea, at rest, without even exerting themself, that's a sign things have progressed to a very poor state, where they're extremely fluid volume overloaded.

02:28 So, we talked about why they have chest pain, because they can't get oxygen down to those thickest parts of the wall.

02:35 We've talked about dyspnea upon exertion.

02:38 Walking across the room, or certain distances, anything that exerts their muscles can cause them to be short of breath much shorter than would be normal for someone without myopathy.

02:49 As if the exertional dyspnea was not bad enough, the patient can also experience dizziness, or lightheadedness, or even in extreme cases, syncope or fainting.

02:59 The reason is, just like we've talked about all along.

03:02 You have poor or inadequate perfusion of tissues because the heart can't pump effectively.

03:09 And those are clear signs that the brain is not getting the level of oxygen it needs.

03:14 Dizzy, lightheaded, and in the worst case, fainting.

03:18 Now, looking at diagnosis.

03:21 Now, we've got a cardiac physical exam.

03:24 This is above and beyond what you would expect to learn in nursing school.

03:28 But I just wanted you to be aware that systolic heart murmur is also something that you can hear on a physical exam.

03:34 If you want to learn more about heart tones, we have a whole course on it.

03:38 But for now, we're just going to stop at a systolic heart murmur.

03:42 Now, we don't have a lot of physical symptoms.

03:46 You know, in some of this can be genetic, right.

03:49 So, hearing a systolic murmur is actually really important.

03:53 So if you're going to learn one heart tone, this would be one that would be critically important for you to know.

03:59 Patient may not have symptoms except the systolic heart murmur.

04:03 And that's a key cue to watch for.

04:07 In the rest of the cardiac physical exam, you're going to be looking for things like look where the midclavicular line is, look at the apical pulse location.

04:16 If apical impulses exaggerated and displace to the left, that's also a sign that there's been some changes in the heart.

04:24 So since you may not see the external signs, these are things you can assess that are going on internally.

04:31 Now, we talked about the psoac murmur.

04:33 You can have an S4 and the systolic murmur.

04:35 Again, those are all key heart tones that you would be listening for.

04:39 I'm going to talk about specific changes that might be visible on an ECG.

04:43 Keeping in mind this is really important, because these may be the first cues that you can pick up on on a physical exam.

04:52 Now the P waves might be biphasic.

04:55 Bi meaning two, two phases. So you see what's going on here.

04:58 Your little dip up and then a dip down.

04:59 That's called the bi-phasic P wave.

05:02 Another change, you could see, as you might see some pathological Q waves.

05:07 Now, you would need 12 leads. That's called a 12 lead ECG.

05:11 Because this looks at the heart from all different angles.

05:14 So you have this pathological Q wave.

05:17 You got some abnormalities, and you're going to see them in very specific leads.

05:21 Now, we've listed those leads there. But this isn't a 12 lead course.

05:26 This is just to let you know what might be some cues that you would find in your patients.

05:30 Now, this one is Tall R waves.

05:34 And that's a really kind of weird one to see.

05:37 So, you got the biphasic P waves, right? You got the pathological Q waves.

05:43 And then you've got some really Tall R waves.

05:47 So these are all signs that clinicians would look for, not just one of these would diagnose a client.

05:52 But we look at these with all the history the other pieces that are going together, this would be one part of the puzzle.

05:59 This is a little more expensive test. A 12 lead ECG.

06:03 You might have even done that in clinicals.

06:05 And echocardiogram requires a person who has been highly trained.

06:10 They have a degree in this, they know what they're doing.

06:13 This isn't something you would do as a nursing student.

06:16 But an echocardiogram can give you a really accurate picture of what's going on in that heart, why it is moving? So this is one of the main diagnostic tools that would be ordered. If the other symptoms came up.

06:28 Hey, I'm hearing some unusual heart tones.

06:32 I'm seeing some things change on a 12 lead.

06:35 The echocardiogram would be the next step for more definitive diagnosis.

06:39 Now, a more invasive one would be a heart catheterization.

06:43 So not everyone would progress to that step.

06:46 But that's how it would go.

06:47 You do a physical assessment. Listen for heart tones.

06:50 You do an ECG and look at. the electrical activity and how it is being moved through the heart.

06:56 If you see things that are suspicious, an echocardiogram would be done.

07:00 And if things are really looking like they need to be followed more closely, the patient would have a heart cath which is a definite invasive procedure.