diminished contractile function of the muscle fibers and diffuse necrosis of myocardial cells.

Results: poor systolic function.

Structural changes of the heart muscle decrease the amount of blood ejected from the ventricles after contraction.

Less blood is able to enter the ventricles during diastole, increasing en-diastole pressure and eventually increasing pulmonary and systemic venous pressures.


Altered valve function, regurgitation, may result due to overstretched ventricles.

Poor blood flow through the ventricle may also cause ventricular or atrial thrombi resulting in emboli travelling to other part of the body.


Condition may remain stable and asymptomatic for years.

  1. Dyspnea on exertion
  2. Low endurance – fatigue
  3. Cough
  4. Orthopnea
  5. edema
  6. nausea
  7. chest pain
  8. palpitations
  9. syncope on exertion

Physical Examination:

  1. Auscultation
  2. tachycardia
  3. S3 and S4
  4. diastolic murmur
  5. crackles on pulmonary auscultation
  6. jugular vein distension on palpitation and inspection
  7. pitting edema of extremities on inspection and palpitation
  8. hepatomegaly on palpitation


  • patient history
  • elimination of other heart failure etiology
  • echocardiogram – allows view of heart structure and ventricles
  • chest X-ray – illustrate presence of cardiomegaly and pulmonary congestion if present
  • Cardiac catheterization – eliminate possible coronary artery disease
  • endomyocardial biopsy – for cardiocellular analysis

Day et al. 2010. Textbook of Canadian Medical-Surgical Nursing. 2nd ed. Lippincott, Williams and Wilkins. Philadelphia.


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