Re: ischemic cardiomyopathy

Posted By CCF Cardio MD-SGM on December 31, 1997 at 10:23:19:

In Reply to: ischemic cardiomyopathy posted by Marlise on December 29, 1997 at 22:26:48:







: My dad has been diagnosed with ischemic cardiomyopathy and after what he's been through, some say he has nine lives.  He is taking every drug under the sun to help with the cardiomyopathy - digoxin, lasix, nitroglycerin, etc.  Plus, he has been taking dilantin to control the grand mal seizures which resulted in his last hospitalization.  He has also been diagnosed with hepatitis C as a result of contaminated blood during his by-pass surgury over 15 years ago (Red Cross blood scandal here in Canada).
At this point he is constantly tired, so tired he can barely move and is further wiped out by daily rounds of nausea .  We suspect that this may be a result of the digoxin.  Is there another "similar" drug that he could be taking?
Also, what are the chances of a heart transplant for someone in his condition?  We realize that his potential for seizures (now controlled with the dilantin) and his hepatitis C are added complications, but does this wipe out the possibility entirely?  He's now 63.
I would appreciate and am grateful for any feedback.



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Dear Marlise,
Digoxin has traditionally been a mainstay in the treatment of heart failure. It has many direct and indirect effects on the heart, and has been shown in large, randomized trials to reduce symptoms of heart failure and increase exercise capacity in this group of patients.  Digoxin, however, has not convincingly been shown to prolong life, and one must weigh the symptomatic benefit it provides with potential side effects and intolerances.  In specific reference to your father's nausea,  I must tell you that heart failure often causes this symptom due to the "backup" of blood in the liver and abdominal organs and the low overall heart output.  Digoxin can certainly cause nausea,  but typically does so when blood levels of this medication are too high.  One consideration might be to stop the digoxin for a period of time to see if the nausea improves, and measure the impact of this isolated change in the treatment regimen.  There is presently no approved digoxin alternative for oral use.  
While on the subject of therapy, it's critical to optimally treat ischemic cardiomyopathy with aggressive medical therapy.  This includes the medicines you mentioned as well as drugs that reduce afterload(vasodilators).  These include ACE inhibitors and hydralazine.  It's important that your father be considered for therapy with these medicines, since they often provide significant improvement in both symptoms and exercise capacity.
Regarding the transplant question...   Transplant is a consideration only when carefully titrated medical therapy has failed to achieve certain goals.  These goals relate to exercise capacity (ability to perform tasks without experiencing limiting symptoms), controlling severe angina unresponsive to therapy, or limiting arrhythmias that are life-threatening.  Certain irreversible medical conditions that would limit the life-expectancy of an individual and advanced age (this is variable, sometimes quoted as >70 years) are some contraindications to transplantation.  Seizure disorder and Hepatitis C are considerations in this equation, but are not absolute contraindications.  That is to say that if transplant were seriously contemplated, the center performing this procedure would need to evaluate your dad's overall medical condition and assess his suitability.  
I hope this response has been helpful.  Information provided in the Heart Forum is for general medical purposes only.  Specific diagnoses and therapies can only be provided by your physician.