Key Concepts
Introduction
Left ventricular noncompaction (LVNC) is a cardiomyopathy characterized by prominent trabeculations and deep intertrabecular recesses in the ventricular myocardium, resulting from arrested embryonic myocardial development. During normal fetal cardiac development, the initially spongy myocardium undergoes compaction from epicardium to endocardium, eliminating the trabecular meshwork. In LVNC, this process is incomplete, leaving a thick noncompacted endocardial layer with deep recesses communicating with the ventricular cavity overlying a thin, compacted epicardial layer. This structural abnormality impairs systolic and diastolic function, creating stagnant blood flow within the deep recesses that predisposes to thrombus formation and embolic events (stroke, systemic embolization). Clinical manifestations include heart failure (systolic dysfunction), arrhythmias (ventricular tachycardia, Wolff-Parkinson-White syndrome), and thromboembolism. The nurse monitors cardiac rhythm continuously, assesses for signs of heart failure, monitors anticoagulation therapy (often prescribed even without documented thrombus due to high embolic risk), performs serial neurological assessments for stroke symptoms, administers heart failure medications (ACE inhibitors, beta-blockers, diuretics), coordinates echocardiographic monitoring, and provides patient and family education about this genetic cardiomyopathy including family screening recommendations. On the exam, writers often pair stable-sounding options with unstable data—notice...