cardiomyopathy in children

Posted By  CCF CARDIO MD-APS on December 02, 1997 at 14:06:44:

In Reply to: cardiomyopathy in children posted by Bonnie Patterson on November 13, 1997 at 16:31:56:

: My daughter Kaitlin has congestive dilated cardiomyopathy.  She was 10 months old when the doctors discovered her in heart failure.  Her ejection fraction at this time was 15%.  Over a period of 5 years, she has had an improvement of ejection fraction to around 35%.  She tires easily and has night sweats along with leg, arm, and chest pain.  Her doctors consider her stable because her heart has not enlarged in the last year.  She takes Digioxin and Accupril twice daily.  My question is about her meds.  She weighs about 40 pounds.  What is the average dose of digoxin and accupril for a child of her size and age.  Also, can she take the new drug Coreg?  And what is the prognosis for someone who has had cardiomyopathy from such a early age? Thanks Bonnie

[CCF CARDIO MD APS]

_
Dear Bonnie,
     I apologize for the delay in answering your question, however I needed to consult with some of our pediatric specialists before answering.  
In general pediatric cardiomyopathy is treated like adult cardiomyopathy, to include an initial evaluation for possible reversible causes( in a child
this would include "holes in the heart", structural abnormalities, metabolic, and nuerologic disorders that effect the heart.  Unfortunately for
children many of the drugs used in adults( and tested in adult populations )are not approved for children but given that the same general rules apply
they are used in children at doses designed to improve the symptoms.  I have not heard of pediatric patients being tried on the drug carvedilol(Coreg)
yet again this is not my subspecialty and given that many more adults have heart disease than children it is easier to evaluate the short and long
term benefits in adults.  An ejection fraction of 35% is still quite low for a child of say 6 years old, however I can not prognosticate for your child alone
but I can say that Kaitlin could potentially need a heart transplant in the future; if you would like a second opinion and or an evaluation of Kaitlin's
cardiomyopathy we have at the Cleveland Clinic a pediatric heart failure/transplant specialist named Dr.Kichuk, you can reach her or the pediatric cardiology
fellow ( Dr.Calderon ) at 1-800-CCF-CARE. I hope that I have answered most of your questions, please submit any further questions you might have at any time.
     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).