Signs And Symptoms

Dilated cardiomyopathy

Fatigue and generalized weakness

Narrow pulse pressure; peripheral edema, and neck vein congestion Orthopnea, dyspnea on exertion, paroxysmal nocturnal dyspnea—signs of left-sided CHF Palpitations and chest pain Pulmonary congestion and pleural effusions Syncope Tachycardia

Hypertrophic cardio-

Angina and palpitations

myopathy

Dysrthythmia, possibly leading to sudden death Loud systolic murmur caused by obstruction of outflow Orthopnea and dyspnea on exertion Pulmonary congestion Sudden loss of pulses Syncope

Restrictive cardio-

Bradycardia

Fatigue and generalized weakness

Peripheral edema, liver congestion, abdominal discomfort, and neck vein distention—signs of right-sided CHF

disorder, or an infiltrative disorder. Determine if the patient has had a recent viral or bacterial infection. Ask female patients if they are pregnant. Question the patient about any hypersensitive reactions to medications or any exposure to radiation.

PHYSICAL EXAMINATION. Assess the patient for signs and symptoms of congestive heart failure, which is the end result of cardiomyopathy. Check for altered mental status as a result of poor cerebral perfusion, and observe for anxiety or restlessness. Note if the patient's skin is cool or damp, and observe it for mottling, pallor, or cyanosis. Inspect the patient for peripheral edema, ascites, jugular venous distension, and hepatojugular reflux. Palpate the patient's abdomen for signs of hepatomegaly. Assess the patient's breathing patterns for shortness of breath, dyspnea, tachypnea, or crackles. Note a decreased blood pressure and bounding or alternating strength of peripheral pulses. Auscultate for heart sounds, and note the presence of an S3 or S4 gallop, valvular murmurs associated with mitral or tricuspid regurgitation, or an outflow obstruction of hypertrophy, tachycardia, and dysrhythmias.

PSYCHOSOCIAL. The patient with cardiomyopathy may experience fear and anxiety as a result of living with a life-threatening, chronic disease process. These feelings may be exhibited by restlessness, insomnia, bouts of anger or withdrawal, or difficulty concentrating. Although some denial and depression are a normal part of the grieving process, if these conditions persist, patients may need assistance in moving on to accept their disease and prognosis.

Diagnostic Highlights

Test Normal Result

Abnormality with Condition

Explanation

Cardiac Normal right catheterization and left values

Right heart catheterization: elevated left and right ventricular end-diastolic and atrial pressures, and decreased cardiac output of the right heart. Left heart catheterization: left ventriculogram may reveal decreased ventricular wall motion and/or mitral regurgitation

Impaired systolic and/or diastolic functioning of the heart

Other Tests: Echocardiogram (two-dimensional and Doppler echocardiography can help differentiate various conditions, such as hypertropic or restrictive cardiomyopathy, pericardial disease, and valvular disorders), radionuclide ventriculography. Supporting tests include sodium levels; blood urea nitrogen (BUN), potassium levels, and creatinine levels; chest x-ray; electrocardiogram (ECG); if the patient has developed CHF as a result of the cardiomyopathy, the following tests might also be obtained: hematocrit, arterial blood gases (ABGs), and coagulation studies.

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