cardiomyopathy with ef of 10%

Woodenpug, BSN · Jun 3, 2009

I'm not sure if symptomatic or not is all that key. Soon enough a tachy chf patient is going to show symptoms. Still, I would need a complete assessment, but coreg and lasix sounds like a good plan. I would also like recent lytes, mag and cardiac enzymes. A 12 lead since the tachy rhythm started would also be useful to see if you wanted to try dil or adenosin.

bluesnurse · Jun 3, 2009

The first thing I'd be looking for is any and all available history on the patient. What's the baseline HR, BP, and EF? What home meds are they on? What's their level of function regarding ADL's and activity?

If the patient is able to converse, they may be very knowledgeable about their condition. If family is present, they can be a key part of the initial assessment. Check on previous admissions. And of course, medical records are your best friend if you can get access to them!

I say this from the perspective of having worked tele and CCU; I'm now a cardiology clinic nurse. I've also done echos for 16 years. And I can attest that there *are* actually people walking around with EF's of 10-20%! No, they're not teaching aerobics, but many manage reasonably well by working within their cardiac limitations. We also see a *lot* of 85YO+ patients who are sharp as tacks, sometimes sharper than I am! Their hearts are failing but their brains are fine

Of course, you're not always going to have the luxury of having access to any of this information. But every little bit can be a huge help in clinical decision-making. :heartbeat

gentle · Jun 5, 2009

Hey everyone,

Sorry it took soooo very long to get back to you. Many other interesting experiences during the time and I almost forgot that I posted about this one. Okay, let's sift through your responses and begin the answering process:

How old is this person. Are they on a transplant list? I never had a person with EF that low. I wouldn't think they would live long no matter what kind of treatment they got.

I agree with Roy lots of questions.
I do know, when we had a pt with a similar EF of around 15% or so, the pt was on the transplant list, and we had orders to administer his meds even if his SBP was in the 90's. The guy was walking around with his SBP in the low to mid 80's most of the time. Sometimes even lower.
How much edema does the pt have and where ? What do the lung sound like? What is the baseline BP for the pt, and is he symptomatic?

No this patient was not and is not on a transplant list. I seriously doubt that they will be. The underlying problem was ETOH abuse, poor cardiac history previously?

Yes, the EF was 10% and no the patient wasn't tolerating it very well. His urine output was barely making the required 30cc/hour. Yes, his lungs did have some rales however, all these issues must be balanced out carefully.

Not enough info. What's the rhythm? Is the pt. symptomatic? How much Coreg? Is Coreg new for them? Any peripheral edema? Lung sounds?

The patient was in a sinus tach. They did need and I did give the coreg without hesitation. I would do this again. A heart with an EF of 10% needs more time to fill. My understanding from reading is that preferrably the heart rate be below 100s.

Lasix was given as ordered. Next day Bun and creat increased, pt bolused and the cardiac dance began again.

Within 72 hours, the waltz had ended, it appeared that the correct person came along who knew how to order the medications and maintain patience. At any rate, the patient's activity tolerance had improved-which initially was exhaustion with rolling to change linens, the tachycardia decreased to a lower tachy (low 100s) bp increased higher 90s and patient's mentation improved dramatically. With the improvements came some of the downside: a bit more rales in the lungs and more edema in the feet as supported by +weight gain of approx 4lbs. And yet, this is what this patient may have needed for quality of life.

It was nice to see the meds titrated to the patient response versus the numbers.

It is indeed a delicate dance- the cardiomyopathy waltz.

shocker29 · Jun 5, 2009

Sounds like this guy needs to be in CCU on a dobutamine drip...maybe even could have used a balloon pump to get him over the hump.

I've never seen a patient with an EF of 10-15 that was not tachycardic! How tachy is the key! Lasix is really important for the heart failure perspective... these guys walk a fine line, so I understand why the lasix was ordered, but like everyone else said... you got to have the big picture!

A cardiologist should have really been running this guys care...