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The Signs and Symptoms’ of Cardiomyopathy: The Awareness and Actions of the Registered Nurse

by Gary D. Goldberg, PhD
Clinical Professor of Medical Education
Angeles College of Nursing, Los Angeles, Ca.

ABSTRACT

     Cardiomyopathies come from many mechanisms, but the conditions may be divided into three major types:  First, dilated or congestive.  Second, hypertrophic, and third, restrictive.  A careful history-taking by the registered nurse or practitioner along with a complete physical examination can reveal cardiomyopathies, but it is appropriate to confirm the diagnosis with a transthoracic echocardiography and selected laboratory studies. 

Key Points – 

Background –

     The hallmark of hypertrophic cardiomyopathy is myocardial hypertrophy (e.g., the myocardium thickening of the wall size and shape), that is inappropriate and often A-symmetric that occurs in the absence of an obvious inciting hypertrophy stimulus.  Although any region of the left ventricle (LV) can be affected, hypertrophy frequently involves the interventricular septum which can result in an outflow tract obstruction.  In many clinical studies regarding the electrophysiology of hypertrophic cardiomyopathy, patients have preserved systolic function with impaired LV compliance that results in diastolic dysfunction whether or not the outflow tract obstruction is present. ¹  

 Clinical Manifestations –

     The nurse- clinician should take extra steps in gathering patient and family history as in asking questions regarding some basic symptoms:  Is there a history of a productive cough and dyspnea, perhaps with wheezing.  Breathlessness limits the patient’s ability in the minor stresses of daily living.  Frequently there is a history of emergency hospital admissions because of respiratory infection, and sometimes necessitating mechanical ventilation.  In breathing oxygen (O₂),  there may be increasing somnolence or other symptoms of hypercapnia such as recurring headaches, confusion, and even vomiting which when combined with blurred optic discs (also, due to cerebral vasodilation), constitutes the “pseudo tumor cerebri” syndrome. ²ʹ³ 

Note:  Hypoxia is usually present due to hypoventilation and sleep- apnea that may worsen at night.  Therefore, it may be wise to have a sleep study done to rule- out any pulmonary disease, along with labs for hemodynamics in patients with questionable obstructive pulmonary disease or episodes of peripheral edema on site. ⁴ 

     Also, in regards to older adults, during the examination the nurse and/or clinician should look for nicotine staining of the fingers, which is a sign reflecting many years of heavy cigarette smoking.  The skin may be warm and the arterial pulse bounding in the high cardiac output state induced by hypoxia and hypercapnia.  The distention of the chest due to the airflow obstruction and the presence of rhonchi and wheezes secondary to chronic bronchitis usually make cardiac auscultation difficult.  Take notice with your cardiac stethoscope of a right-sided protodiastolic galloping sound (S₃) and a systolic murmur of the tricuspid regurgitant which may be audible. 

Note:  As a registered nurse or treating practitioner, if you are given the opportunity to be with your patient while the service of a 2-D Echo is being performed, please ask the clinician while he or she is recording in the short axis mode, to listen and investigate heart sounds, by placing your cardiac stethoscope over the apex and moving it over the chambers to hear the various sounds. This will bring alive your sense of sight and sounds to a new level. 

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