Left Ventricular Systolic Dysfunction Precipitated by Verapamil in Cardiac Amyloidosis

Pollak, Arthur; Falk, Rodney H.

doi:10.1378/chest.104.2.618

Cited by 106 publications

(60 citation statements)

References 5 publications

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“…56 Similarly, calcium antagonists bind to amyloid fibrils, which can result in exaggerated hypotensive and negative inotropic responses. 57 Ultimately, judicious diuresis remains the mainstay of HF therapy in these patients. ACE inhibitors, or angiotensin receptor blockers (ARBs) if the patient is intolerant of ACE inhibitors, should be used with caution in patients with amyloidosis and probably should be avoided because of hypotension.…”

Section: General Hf Treatmentmentioning

confidence: 99%

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Bozkurt¹,

Colvin²,

Cook³

et al. 2016

Circulation

603

663

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CLINICAL STATEMENTS AND GUIDELINEST he intent of this American Heart Association (AHA) scientific statement is to summarize our current understanding of dilated cardiomyopathies. There is special emphasis on recent developments in diagnostic approaches and therapies for specific cardiomyopathies. Recommendations in this document are based on published studies, published practice guidelines from the American College of Cardiology (ACC)/AHA 1 and other organizations, 2,3 and the multidisciplinary expertise of the writing group. Existing evidence in epidemiology, classification, diagnosis, and management of specific cardiomyopathies is usually derived from nonrandomized observational studies, registries, case reports, or expert opinion based on clinical experience, not large-scale randomized clinical trials or systematic reviews. Therefore, in this document, rather than using the standard ACC/AHA classification schema of recommendations and level of evidence, 4 we have included key management strategies at the end of each section and categorized our recommendations according to the level of consensus. Although the format of our recommendations might resemble the ACC/AHA classification of recommendations used in the ACC/AHA practice guidelines, because of the preponderance of expert opinion or level of evidence C evidence in our document, we elected to use different terminology to provide a distinction from the practice guidelines, in which stronger levels and quality of evidence with randomized clinical trials or meta-analyses are usually present. 4 The levels of evidence follow the AHA and ACC methods of classifying the level of certainty of the treatment effect. 4 DEfINITIoN of DILATED CArDIoMyopAThyThe term dilated cardiomyopathy (DCM) refers to a spectrum of heterogeneous myocardial disorders that are characterized by ventricular dilation and depressed myocardial performance in the absence of hypertension, valvular, congenital, or ischemic heart disease. 5 In clinical practice, the pathogenesis of heart failure (HF) has often been placed into 2 categories: ischemic and nonischemic cardiomyopathy. The term nonischemic cardiomyopathy has been interchangeably used with DCM. Although this approach might be practical, it fails to recognize that nonischemic cardiomyopathy can include cardiomyopathies caused by volume or pressure overload (such as hypertension or valvular heart disease) that are not conventionally accepted under the definition of DCM. 1,5 Again, in general practice and clinical research trials, the term ischemic cardiomyopathy is defined as cardiomyopathy caused by ischemic heart disease. Current use of ischemic cardiomyopathy terminology implies ventricular dilation and depressed myocardial contractility caused by ischemia or infarction. CLASSIfICATIoN of CArDIoMyopAThIESThe first classification on this topic categorized cardiomyopathies as heart muscle diseases with dilated (DCM), hypertrophic, restrictive, arrhythmogenic right ventricular (ARVC), or nonclassifiable cardiomyopathy in 1980. 5 Subse...

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Section: General Hf Treatmentmentioning

confidence: 99%

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

Bozkurt¹,

Colvin²,

Cook³

et al. 2016

Circulation

603

663

View full text Add to dashboard Cite

show abstract

“…Calcium channel blockers are contraindicated because they often produce a significant negative inotropic effect. 72,73 On occasion, I have been able to maintain patients on oral nitrates for preload reduction, but they often have only a minor benefit and require cautious introduction and gradual dose escalation. There are no published data on the use of intravenous inotropic or vasodilator drugs in patients with severe heart failure resulting from amyloidosis.…”

Section: Managementmentioning

confidence: 99%

Diagnosis and Management of the Cardiac Amyloidoses

2005

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“…While in AL amyloid "conventional" heart failure treatment including beta blockers and angiotensin pathway inhibitors is usually not well tolerated, these medications may be better tolerated in ATTR patients who do not suffer from significant autonomic neuropathy. Calcium channel blockers with negative inotropic effects have no role in AL amyloid and may cause harm [103] [104]. Compared to other causes of heart failure there is no evidence for remodeling effects from beta blockers and therefore they are not indicated for patients in sinus rhythm [105].…”

Section: Conventional Heart Failure Treatmentmentioning

confidence: 99%