Hypertrophic cardiomyopathy treatment

Sorcin is associated with the development of multidrug resistances in leukemia and other cancels. Sorcin is also able to improve cardiac contractility independently of (3-adienergic stimulation and may prove beneficial in treatment of heart failure. A point mutation in sorcin causes familial hypertrophic cardiomyopathy. 

Verapamil and a few newer dmgs of this category are vasodilator agents, which in addition impair AV conduction, reduce heart rate and cardiac contractile force. Verapamil was initially developed for the treatment of supraventricular tachycardia and it continues to be an important drug for the management of this condition, also postoperatively. Verapamil is the CA of choice in the management of hypertrophic cardiomyopathy. Verapamil is also used in the treatment of stable angina and, less frequently, essential hypertension. 

Unlabeled Uses Treatment of anxiety, chronic angina pectoris, hypertrophic cardiomyopathy, MI, pheochromocytoma, syndrome of mifral valve prolapse, thyrotoxicosis, tremors... 

Unlabeled Uses Acute alcohol withdrawal, arrhythmia (especially supraventricular and ventricular tachycardia), improved survival in diabetics with heart disease, mild to moderately severe CHF (adjunct) prevention of migraine, thyrotoxicosis, tremors treatment of hypertrophic cardiomyopathy, pheochromocytoma, and syndrome of mitral valve prolapse... 

Unlabeled Uses Treatment of arrhythmias, hypertrophic cardiomyopathy. Ml, mitral valve prolapse syndrome, neuroleptic-induced akathisia, pheochromocytoma, tremors, thyrotoxicosis, vascular headaches... 

Uniabeled Uses Treatment of chronic angina pectoris, hypertrophic cardiomyopathy, tremors, and mitral valve prolapse syndrome. Increases antidepressant effect with fluoxetine and other SSRIs. 

Unlabeled Uses Systemic-. Treatment of anxiefy, cardiac arrhyfhmias, chronic angina pecforis, hypertrophic cardiomyopathy, migraine, pheochromocytoma, thyrotoxicosis, tremors... 

Approximately 25% of all patients with hypertrophic cardiomyopathy (HCM) have latent left ventricular outflow obstruction with an intraventricular gradient (I). Pathophysiologic features are asymmetric hypertrophy of the septum and a systolic anterior movement of the anterior leaflet. Medical treatment includes betablockers, and calcium antagonists of the verapamil type. Approximately 5— 10% of the patients with outflow obstruction are refractory to such negative inotropic therapy (2). Positive inotropic drugs such as digitalis or sympathomimetics are strictly contraindicated. In the presence of atrial fibrillation, anticoagulation therapy should be started. Since endocarditis is more common in patients with HCM because of turbulence in the left ventricle, prophylactic antibiotics should be administered for periods of potential bacteraemia. 

Tacrolimus is a macrolide immunosuppressant agent that is isolated from a bacterium. It acts like ciclosporin and is used to protect and treat liver and kidney grafts when conventional immunosuppressants fail. Such rescue treatment may be graft-or life-saving. Tacrolimus may cause nephrotoxicity, neurotoxicity, disturbance of glucose metabolism, hyperkalaemia and hypertrophic cardiomyopathy. 

Nishida K, Fujiki A, Mizumaki K, Nagasawa H, Sakabe M, Sakurai K, Inoue H. Exercise-induced ventricular fibrillation during treatment with cibenzoline in a patient with hypertrophic cardiomyopathy. Ther Res 2001 22 832-6. 

Verapamil, proprietaiy name Calan, is a calcium channel blocker that is effective in the treatment of various cardiovascular disorders, including angina (classical and variant), arrhythmias (paroxysmal supraventricular tachycardia), atrial flutter, atrial fibrillation, hypertrophic cardiomyopathy (idiopathic hypertrophic subaortic stenosis), hypertension, congestive heart failure, and Raynaud s phenomenon, along with the preservation of ischemic myocardium and the treatment of migraine headaches. 

Treatment strategies for patients with hypertrophic cardiomyopathy (HCM) are aimed at improving symptoms and... 

FIGURE 18-4. Treatment algorithm for hypertrophic cardiomyopathy. ACEI = angiotensin-converting enzyme inhibitor NSVT = nonsustained ventricular tachycardia ICD = implantable cardioverter-defibrillator LV = left ventricular SCD = sudden cardiac death. 

In addition, iPSC-CMs have been used to model structural heart diseases, including familial dilated cardiomyopathy (DCM) (Sun et al., 2012) and hypertrophic cardiomyopathy (HCM) (Lan et al., 2013) caused by mutations in cardiac troponin T (cTnT) and myosin heavy chain 7 (MYH7), respectively. In both studies, iPSC-CMs recapitulated the disease phenotype at the cellular level with pharmacological rescue by chronic treatment with p-adrenergic blocker (propranolol or metoprolol) or the L-type Ca channel blocker (verapamil) (Sun et al., 2012 Lan et al., 2013) (Table 22.1). Collectively, these studies reinforce the ability of iPSC-CMs to model channelopathies and cardiomyopathies as well as to test the clinical efficacy of drugs. 

Gietzen FH, Leuner CJ, Raute-Kreinsen U, et al. Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH), Catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J 1999 20(1 8) 1342-1354. 

Nagueh Sp Ommen SR, Lakkis NM, et al. Comparison of ethanol septal reduction therapy with surgical myectomy for the treatment of hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 2001 38 1701 -1706. 

McCully RB, Nishimura RA, Tajik AJ, et al, Extent of clinical improvement after surgical treatment of hypertrophic obstructive cardiomyopathy. Circulation 1996 94 467-471,... 

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