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Cardiomyopathy: Medications

March 6, 2022


Treatment of cardiomyopathy depends on the etiology of the cardiomyopathy. Most of the conditions that lead to cardiomyopathy don’t have a good treatment. You’re unlikely to be able to change the genetics of somebody who has hypertrophic cardiomyopathy. But we do have medications that actually delay the progression of the cardiomyopathy and actually can also treat the complication developing heart failure. And so these medications include beta blockers that affect and block the effect of adrenaline, include ACE inhibitors, angiotensin converting enzyme inhibitors, that are actually there that help reduce the progression of heart failure in patients with cardiomyopathy, and sometimes helping the remodeling and strengthening of the heart muscle. Their cousin angiotensin receptor blockers do similar things for the heart muscle. And then a newer agent called Entresto, which is an angiotensin receptor combined with what they call a neprilysin inhibitor, actually helps reduce the symptoms and admissions related to heart failure.

And patients with heart failure often have improvement of their ejection fraction or their weakening of their heart muscle by taking Entresto. We use drugs such as spironolactone or eplerenone that affect the aldosterone mechanism that reduce scarring of the heart and progression of scarring. And these are the medications that we commonly use to treat the etiologies and the consequences of cardiomyopathy. Now, those patients that have cardiomyopathy that develop heart failure, we sometimes use drugs such as dijoxin for symptoms and drugs such as furosemide, which is a diuretic or as we call a water pill that gets rid of excess fluid. Patients with cardiomyopathy are at higher risk for developing cardiac arrhythmias. One such arrhythmia is atrial fibrillation. Patients with atrial fibrillation will need control of their rhythm. So they might need anti arrhythmics. Those patients may also need rate controlling medications, such as beta blockers and calcium channel blockers. And those patients often need thinning of the blood to reduce the risk of stroke as complication of atrial fibrillation.

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