Cardiomyopathy medical therapy: Difference between revisions
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* Reduce [[inflammation]]. | * Reduce [[inflammation]]. | ||
** [[Corticosteroids]] are an example of a medicine used to reduce [[inflammation]]. | ** [[Corticosteroids]] are an example of a medicine used to reduce [[inflammation]]. | ||
*The 2009 Heart Failure Society of America (HFSA) guidelines note that the finding of a specific mutation does not generally govern therapy, although certain clinical characteristics associated with some genes may influence screening, education, and counseling of family members, and the threshold for primary prevention (eg, implantable cardioverter-defibrillator use) or presymptomatic therapy (eg, beta-blocker or angiotensin converting enzyme inhibitor administration). | |||
*Medical therapy is recommended based on cardiac phenotype as outlined in the general guidelines. Early initiation of therapy (eg, with angiotensin converting enzyme inhibitors) has been proposed to slow progression in patients with LV enlargement, even in the absence of a reduced LVEF . However, the efficacy of treating asymptomatic LV dysfunction has only been demonstrated in patients with a LVEF ≤35 to 40 percent. | |||
*Device therapies for conduction system disease and arrhythmia (pacemaker therapy and implantable cardioverter-defibrillator) are recommended based on cardiac phenotype as recommended in major society guidelines. | |||
*In addition, in patients with dilated cardiomyopathy (DCM) and significant arrhythmia or known risk of arrhythmia, an implantable cardioverter-defibrillator may be considered before the LV ejection fraction (LVEF) falls to ≤35 percent (the usual LVEF threshold for prophylactic implantable cardioverter-defibrillator placement). Specifically, an implantable cardioverter-defibrillator may be considered in patients with DCM with EF >35 percent with family history of sudden cardiac death OR with LMNA mutation (associated with high risk of sudden death). | |||
*When a new diagnosis of idiopathic DCM is made, a three to four generation family history and clinical screening of first-degree relatives is indicated. Clinical screening (history, exam, electrocardiogram, and echocardiogram) has been recommended for first-degree relatives to identify asymptomatic or undetected disease. | |||
*Genetic testing with appropriate genetic counseling is indicated for known familial DCM to facilitate risk assessment of family members. Genetic testing for nonfamilial but a well-established DCM diagnosis without other obvious cause is reasonable in many cases. | |||
*The finding of a specific mutation does not generally govern therapy, although certain clinical characteristics associated with some genes may influence screening, education, and counseling of family members, and the threshold for primary prevention (eg, implantable cardiac defibrillator use) or presymptomatic therapy (eg, beta-blocker or angiotensin converting enzyme inhibitor administration). | |||
==ACC/AHA 2017 guidelines == | ==ACC/AHA 2017 guidelines == | ||
Revision as of 18:44, 15 April 2019
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Cardiomyopathy Microchapters |
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Diagnosis |
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Treatment |
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Guidelines |
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2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy |
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Case Studies |
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Cardiomyopathy medical therapy On the Web |
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American Roentgen Ray Society Images of Cardiomyopathy medical therapy |
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Risk calculators and risk factors for Cardiomyopathy medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Treatment depends on the type of cardiomyopathy, but may include medication, implanted pacemakers, defribillators, or ventricular assist devices (LVADs), or ablation. The goal of treatment is often symptom relief, and some patients may eventually require a heart transplant. Treatment of cardiomyopathy (and other heart diseases) using alternative methods such as stem cell therapy is commercially available but is not supported by convincing evidence.
Medical Therapy
Medications may be prescribed for the following reasons:[1]
- Lower the blood pressure.
- ACE inhibitors, angiotensin II receptor blockers, beta blockers, and calcium channel blockers are examples of medicines that lower blood pressure.
- Slow the heart rate.
- Beta blockers, calcium channel blockers, and digoxin are examples of medicines that slow the heart rate. Beta blockers and calcium channel blockers also are used to lower blood pressure.
- Keep the heart beating with a normal rhythm.
- These medicines, called antiarrhythmics, help prevent arrhythmias.
- Balance electrolytes in the body.
- Electrolytes are minerals that help maintain fluid levels and acid-base balance in the body. They also help muscle and nerve tissues work properly. Abnormal electrolyte levels may be a sign of dehydration (lack of fluid in your body), heart failure, high blood pressure, or other disorders. Aldosterone blockers are an example of a medicine used to balance electrolytes.
- Remove excess fluid and sodium from the body.
- Diuretics, or "water pills," are an example of a medicine that helps remove excess fluid and sodium from the body.
- Prevent blood clots from forming.
- Anticoagulants, or "blood thinners," are an example of a medicine that prevents blood clots. Blood thinners often are used to treat blood clots in people who have dilated cardiomyopathy.
- Reduce inflammation.
- Corticosteroids are an example of a medicine used to reduce inflammation.
- The 2009 Heart Failure Society of America (HFSA) guidelines note that the finding of a specific mutation does not generally govern therapy, although certain clinical characteristics associated with some genes may influence screening, education, and counseling of family members, and the threshold for primary prevention (eg, implantable cardioverter-defibrillator use) or presymptomatic therapy (eg, beta-blocker or angiotensin converting enzyme inhibitor administration).
- Medical therapy is recommended based on cardiac phenotype as outlined in the general guidelines. Early initiation of therapy (eg, with angiotensin converting enzyme inhibitors) has been proposed to slow progression in patients with LV enlargement, even in the absence of a reduced LVEF . However, the efficacy of treating asymptomatic LV dysfunction has only been demonstrated in patients with a LVEF ≤35 to 40 percent.
- Device therapies for conduction system disease and arrhythmia (pacemaker therapy and implantable cardioverter-defibrillator) are recommended based on cardiac phenotype as recommended in major society guidelines.
- In addition, in patients with dilated cardiomyopathy (DCM) and significant arrhythmia or known risk of arrhythmia, an implantable cardioverter-defibrillator may be considered before the LV ejection fraction (LVEF) falls to ≤35 percent (the usual LVEF threshold for prophylactic implantable cardioverter-defibrillator placement). Specifically, an implantable cardioverter-defibrillator may be considered in patients with DCM with EF >35 percent with family history of sudden cardiac death OR with LMNA mutation (associated with high risk of sudden death).
- When a new diagnosis of idiopathic DCM is made, a three to four generation family history and clinical screening of first-degree relatives is indicated. Clinical screening (history, exam, electrocardiogram, and echocardiogram) has been recommended for first-degree relatives to identify asymptomatic or undetected disease.
- Genetic testing with appropriate genetic counseling is indicated for known familial DCM to facilitate risk assessment of family members. Genetic testing for nonfamilial but a well-established DCM diagnosis without other obvious cause is reasonable in many cases.
- The finding of a specific mutation does not generally govern therapy, although certain clinical characteristics associated with some genes may influence screening, education, and counseling of family members, and the threshold for primary prevention (eg, implantable cardiac defibrillator use) or presymptomatic therapy (eg, beta-blocker or angiotensin converting enzyme inhibitor administration).
ACC/AHA 2017 guidelines
- AHA/ACC 2017 Class 1 recommendation: The clinical strategy of inhibition of the renin-angiotensin system with ACE inhibitors (Level of Evidence: A), OR ARBs (Level of Evidence: A), OR ARNI (Level of Evidence: B-R) in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients is recommended for patients with chronic HFrEF to reduce morbidity and mortality.
- AHA/ACC 2017 guidelines: Class 2a recommendation, Level of Evidence: B-R: Ivabradine can be beneficial to reduce HF hospitalization for patients with symptomatic (NYHA class II-III) stable chronic HFrEF (LVEF ≤35%) who are receiving GDEM, including a beta blocker at maximum tolerated dose, and who are in sinus rhythm with a heart rate of 70 bpm or greater at rest.
- AHA/ACC 2017 guidelines: Class 1 recommendation, Level of Evidence: B: Systolic and diastolic blood pressure should be controlled in patients with HFpEF in accordance with published clinical practice guidelines to prevent morbidity.
References
- ↑ Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (October 2013). "2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J. Am. Coll. Cardiol. 62 (16): e147–239. doi:10.1016/j.jacc.2013.05.019. PMID 23747642.