Cardiomyopathy medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lina Ya’qoub, MD; Edzel Lorraine Co, DMD, MD[2]

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.

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.

• 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 guideline-directed management and therapy (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.

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