Dilated Cardiomyopathy/Coreg

Posted By  CCF CARDIO MD sc on February 23, 1998 at 10:24:05:

In Reply to: Dilated Cardiomyopathy/Coreg posted by Gene on February 18, 1998 at 12:25:41:

: I am a 48 year old male diagnosed with DCM in June 97 with no CHF symptoms.
  Tests showed that I have PVC's and an echo showed an "mildly" enlarged LV
  and a MUGA showed a EF of 44%. I started taking .25mg Lanoxin once a day
  and 10mg Accupril twice a day.  My latest MUGA 12/97 showed my EF to be
  46%. I understand that the MUGA test has a +-5% error rate so basically
  I have stabilized.
  My question is: when is the drug Coreg warranted.
  I don

[CCF Cardio MD sc]

Dear Gene
Although first used in Sweden in the 1970s, Beta blocker therapy for heart failure has just recently come to the forefront as part of the armamentarium in the treatment of congestive heart failure. There are many different classes of beta blockers depending on which receptors are effected. Carvedelol apart from the usual beta blocker effects also has vasodilator properties ( opens up the peripheral blood vessels, thus lowering the blood pressure and the resistance against which the heart has to work). It has been shown to be very effective in the treatment of Class II-Class IV congestive heart failure with reduction in death and hospitalization in patients receiving treatment with digoxin, ACE inhibitors or digoxin.
You however have no symptoms and would not fit in this patient profile. As yet there  are no randomized trials suggesting that early treatment would render an improvement in function and prognosis. A review of the literature for the use of carvedelol in the treatment of heart  Class I failure ( Shortness of breath at severe exertion ) only revealed one small (40patient) non randomized trial in patients with EF of 40% . Again this does not fit your profile and at this point there is no clinical indication for you to be started on this medication and it is unclear from data available that if you do start on it that you will benefit stay the same or have a worse outcome.  The best option for you at this point would be to continue on your current medical therapy with follow up with your cardiologist she or she may see fit.
If you  would like to ask any further questions or would like to see one of our heart failure specialists here at the clinic please feel free to call 1-800-CCF-CARE to set this up.
Information in this forum is intended for general purposes only specific diagnosis and treatment should be reserved for physicians directly involved in patient care.