Question Title: Cozaar / Rehab / Accuracy

My wife Kathy (34 year old) was diagnosed with Left Ventricular dysfunction 11 months ago ago with an EF of 45 - 50%.
Last week an echocaridiagram showed an EF of 30 - 35%. A follow up MUGA put her EF at 37%, with LV wall contractility and considerable cardiac rhythm abnormality.
LV sizes were measured at 5.2 and 3.9 cm, 11 months ago. Today measurements are 5.4 and 4.0 cm
Presently this is being diagnosed as dilated cardiomyopathy, physical symptoms are fatique and loss of appetite.
Treatment for the first 11 months was Acupril which was changed to 50 mg of Cozaar, once a day, due to severe cough.
Current treatment (as of last week) is 3.125 mg of Coreg twice a day along with 50 mg Cozaar twice a day (doubled). Plan is to further increase Coreg dosage?
In your forum I see that you recommend Zestril over Cozaar, should we switch? What are the side effects of Zestril?
I also see mention of supervised cardiac rehabilitation programs in your forum. What is a cardiac rehabilitation program? Is this something we should look into.
Is there any other treatment strategy we should be pursuing?
What is the signficance to the .2cm growth in th LV?
Why the difference in readings between the echocardiagram and the MUGA? do we go with the 30 - 35%, or 37%? Is the decrease over 11 months 8% or 20%?

Presently the next course of action is to do another echocardiagram in 12 months ... this seems like a long time given the recent decline. When would you recommend conducting the next test?
It is comforting to see the positive results sited within your forum, we are hoping this will be the case for Kathy. But if the decline continues, where to we go from there?

Any questions that you can answer would be greatly appreciated,

Thanks,
Bill

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Dear Bill,
I am assuming number one that your wife's dilated cardiomyopathy has no found
cause such as alcohol, post-partum(occuring months after a pregnancy),etc and
therfore there is only treatment and hope that it will get better as opposed
to some direct cause that can be targeted. The following are some answers to
your direct questions:
1)No you should not switch to zestril as this is of the same class as acupril (class = ace-inhibitors)
and therefore will cause the severe cough too. Cozaar is in a different
class (angiotensin II receptor blocker)that is newer, has a different mechanism of action, and at present should only be started after the
patient has developed a cough on the first class This is because all of the
benefits of ace-inhibitors have been proven in large scale trials or studies and although we know that this
newer second class works on the same problematic system in heart failure, we do
not have studies that prove it benefits the patient as much as the first class does (these trials are underway.)
2)All the possible side effects of zestril can be found in a physician's desk
reference or on the drug labeling when the drug is prescribed. These side effects range from headache to hypotension (dangerously low blood pressure).
The most likely one though, that keeps patients from taking the drug is the cough which is usually unremitting and not related to dose.
Since cozarr works by a different mechanism it is unlikely to cause the cough.
3)A cardiac rehabilitation program is one that involves the patient coming a few times a week (more or less)
to have supervised exercise that increases in intensity with time at a preprogramed pace. The rehab. centers are usually staffed by an exercise physiologist and
some trainer type persons. It is of the utmost importance in almost all cases of heart failure that the patient do daily exercise.
Often the patient will leave the program once they feel comfortable with continuing the exercise on their own.
4)I can not of course prescribe treatment on the web but I can comment that the drugs your wife is on include the 'latest and geatest' that we currently have to offer to heart failure patients.
5)The significance of such a small change in diameter could not be commented on except maybe by her own physician; of course we all hope that with each echocardiogrm performed that things look better
however the real test of whether or not things are better is how the patient feels, surely not a few millimeters difference on an echocardiogram. In very much the same manner there is no reason at all to do
serial echocardiograms(every couple of months) as this has no effect on the prognosis nor on the treatment of heart failure.
Lastly, a MUGA and an echo. are two totally different techniques that very often do not agree on the actual ejection fraction. The one to believe is really the one that correlates better
with the patient's symptoms. Good Luck. Information provided in the Heart Forum is intended for general medical informational purposes only, actual diagosis and treatment can only be made by your physician(s).

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