Medication

Medications commonly used to treat heart failure associated with dilated cardiomyopathy, ischemic cardiomyopathy and restrictive cardiomyopathy include:

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Beta-adrenergic (beta) blockers may be prescribed to slow the heart rate and lower blood pressure by reducing the affect of adrenaline on the heart. By slowing the heart rate, beta blockers decrease the heart's demand for oxygen, which decreases the workload on the heart, lessening the symptoms of heart failure. Beta blockers can prevent further heart enlargement and scarring and decrease the risk of sudden death. Beta blockers have also been shown to increase survival by about 30-35 percent in patients with dilated cardiomyopathy. In most cases, your doctor will start you on a low dose of beta blockers, then slowly increase the dose over time until the desired results are achieved.

Diuretics, commonly called water pills, help relieve excess fluid in the body by promoting urine production in the kidneys. This decreases symptoms of shortness of breath, swelling, and bloating. Diuretics vary in potency and speed, and doctors sometimes prescribe a combination of diuretic agents. Diuretics can improve symptoms, but they also activate hormones in the body such as adrenaline that can worsen heart and kidney function. This is why they are used in conjunction with other medicines such as beta blockers and ACE inhibitors.

Positive inotropic medications can beused to strengthen the contractions of the heart in people with severe dilated cardiomyopathy. Examples of these drugs include digoxin, dopamine, dobutamine, and milrinone. Digoxin has been used for over 200 years to improve heart contractions and seems to work best in people who have severe heart failure complicated by atrial fibrillation because digoxin can slow a rapid heart rate. With the exception of digoxin, these drugs are usually only used for a short period of time, or when there are no other treatment options, due to concern that inotropic agents may actually accelerate the degeneration of the heart by forcing an already weakened organ to work harder. Positive inotropic medications should never be used by people with hypertrophic cardiomyopathy because they can exacerbate this condition.

Vasodilators are commonly used to reduce symptoms of heart failure and can prolong the life of people with dilated cardiomyopathy. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are examples of vasodilators, which cause blood vessels throughout the body to relax. This decreases the resistance to blood flow, measured as blood pressure, which in turn reduces the workload on the heart. These medicines can also reverse the enlargement and scarring of the heart, decrease the risk of hospitalization and death, and improve symptoms. Other vasodilators include hydralazine and nitrates, which also reduce the workload of the heart and have been shown to improve symptoms and survival in dilated cardiomyopathy.

Aldosterone blockers are used to help balance electrolytes in the body and also to prevent heart and blood vessel scarring, stiffening, and enlargement. Studies have shown that aldosterone blockers can improve survival in patients with severe dilated cardiomyopathy and those who have had a heart attack complicated by cardiomyopathy.

Antiarrhythmic drugs alter the way in which electrical currents are transmitted through the heart muscle. The heart pumps most efficiently when it beats in a regular rhythm; antiarrhythmics can increase the efficiency of the heart by regulating the heart rhythm. These drugs are used only in selected patients because they can have significant side effects.

More detailed information on dosages and precautions for each of these types of drugs can be found on the National Institute of Health Medline website.