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Coreg Effectiveness in Strengthening Heart Muscle
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Coreg Effectiveness in Strengthening Heart Muscle


  How effective is Coreg in strengthening the heart muscle after the development of an enlarged heart?  Will it actually reduce the size of the heart muscle?  Currently I am taking Cozaar, Coumadin, Demadex, and Dygoxin.  
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Dear Chet,
Coreg (carvedilol) is one of many drugs used in heart failure, however it is unique in that it
incorporates two modalities, alpha and beta blockade.  Without getting in to the pathophysiology which
is not completely understood I will attempt to explain how heart failure/cardiomyopathy studies have come
about as it is quite unlikely that any medication actually strengthens the heart.  There are drugs called
positive ionotropes that work to make the heart pump better but given their risk profile and the fact that
they certainly do not cause any recovery of heart function, they are reserved as end-stage therapies.
There are different ways to treat heart failure that depend on factors like how severe it is, how severe are
the symptoms in the patient, and what is the etiology.  Regardless there are medications that have been proven
time and time again to significant improve heart failure and even lessen its eventual progression that occurs
in most cases.(you are on such medications yourself)  
   Initially drugs were designed to take the pressure off the heart (alpha blockers)which as one would expect
lowered the blood pressue when taken thereby reducing the pressure head that the left ventricle faced with each beat.
Unfortunately when this theory took off and was pushed to the limit it became detrimental in some cases and simply with-out
benefit in others.  Hence this pressure model gave way to a hormonal model whereby drugs were developed that altered hormones
in the body that seemed to be affecting the circulatory system in general.  Thus the ace-inhibitor was born, and for those with
severe cough on this medication, there are now the angiotensin receptor blockers such as the one you are on (cozzar).  The ace inhibitor
also lowers blood pressure and it has been shown scientifically to improve heart failure symptoms and even mortality.  
   As you may have already guessed, a lot of what we do for heart failure patients occurs after the heart has failed.
And very few patients with heart failure ever have a return of normal function of their heart, the likelihood depending of course
on the etiology of the heart failure.(for example, the viral induced cardiomyopathy promises potential recovery as does post partum cardiomyopathy, however
heart failure following many heart attacks surely will not return to normal.  I hope that this discussion gives you a better understanding of
your condition as well as your medical management.  Just so you know coreg is a drug that incorporates both the pressure model and the hormonal model of heart
failure treatment and in it's initial ongoing trial has shown great promise (reduction in mortality-death, as well as improvement in clinical symptoms of
congestive heart failure.  Good Luck.
   Information provided in the heart forum is intended for general medical informational purposes only, actual diagnosis and treatment
can only be made by your physician(s).





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