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Peripartum Cardiomyopathy and being off Coreg

  Hello, I was diagnosed with PPCM, EF 30% no syptoms of CHF in Dec 97. I was
  placed on Coreg and Coumadin. EF 35% Feb 98.  Had Radio Frequency Ablation
  to correct RVOT w/ bigemny on March 98.  June 98 EF was 52% with no abnormal
  heart structure. Still no CHF syptoms.
  I have been off Coreg for 3 days. I feel fine. Even have a bit more energy.
  I was taken off coumadin after RFA.  
  Questions:  How long does one have to be off Coreg for it to be out of the
              If I was having side effects how long before they correct them-
              I had a lot of syptoms related to hypothyroidism but all blood
              work cam back normal.  Could coreg mess up other hormones
              I have hair falling out, dry skin and horrible premenstrual
              syptoms all related to mental depression, anger control, I
              never had this before but I don remember starting to feel like
              this a few after hitting my 12.5mg 2 times a day dosage. With each
              cycle it would be worse.  
   I go for a follow up MUGA in April. Is this enough time to be off the medication
  to see that my heart has recovered and is working normal?
  I guess since I haven't met anyone who has recovered and have  
  been taken off medication and other patients question me being taken off
  medication I guess I am concerned. I want to beleive in recovery but I don't
  see anyone recovered without medication.
  As always I thank you for your time and patience in dealing with a mom who
  is scared of this disease and needs information and reassurance.
1 Responses
238668 tn?1232735930


Dear Jamie,
Thank you for your questions. I have enclosed information on peripartum cardiomyopathy and coreg along with potential side-effects.   It should be out of your system in a few days.  About a third of individuals with this condition get better  - so be encouraged by the good news.
Post-Partum (or peripartum) cardiomyopathy is a relatively rare form of heart failure that affects women during or following pregnancy.  Establishing a diagnosis requires 1. The absence of a determinable cause for cardiac failure, 2. Absence of preexisting heart muscle disease, and 3. Time limitations of onset of illness from the last month of pregnancy to the first 5 post-partum months.  Peripartum cardiomyopathy complicates 1 of 1300 to 4000 deliveries in the United States.  This condition may affect women of any race, age, or number of prior deliveries; however, older, multigravida, African American and twin pregnancies are thought to represent predisposing features.  The cause is unknown.  
The treatment is standard heart failure medication (diuretics, digoxin, ACE inhibitors) and in severe cases heart transplant.  Approximately half of patients with this diagnosis will return to normal within 6 months.  Of those who do not return to normal the prognosis is poor with an average survival of 4.7 years after diagnosis (without transplant).  Repeat pregnancies are not recommended for women who have had peripartum cardiomyopathy.  You can find additional information in the following articles.  (your local medical library should be able to help you find these).
Lampert, MB Lang RM. Peripartum cardiomyopathy. Am Heart J 1995; 130:860-870.
Huerta EM, Erice A, Espino RF, et al. Postpartum cardiomyopathy and acute myocarditis. Am Heart J 1985; 110:1079-1081.
Carvedilol (brand name -Coreg) belong to  a class of medications called beta-blockers.  This class includes the following other medications: generic (brand name), - propranolol (Inderal), atenolol (Tenormin), Labetalol (Normodyne, Trandate), metoprolol (Lopressor), pindolol (Viskin), Nadolol (Corgard), and sotalol (Betapace).  These drugs work by binding to a receptor called the beta receptor.  Once this receptor is blocked the drug exerts its effect in various methods.  The heart rate is slowed, the blood pressure is lowered and heart rhythms are stabilized.  
Beta-blockers are used to treat high blood pressure, angina (chest pain), heart attacks, heart rhythm problems such as atrial fibrillation and more recently heart failure.  
Potential side effects include: >10 % mental depression, tiredness, weakness, dizziness
1-10% Bradycardia (slow heart rate), wheezing, irregular heart beat, reduced peripheral circulation, heartburn
<1% Rash, chest pain, constipation, decreased sexual activity, itching, nausea, vomiting, stomach discomfort, insomnia, heart failure, nightmares, confusion, headache, impotence, cold extremities.
Potential drug interactions include:
Increased effect of metoprolol - amiodarone, cimetidine, diltiazem, nifedipine, nicardipine, verapamil, flecainide, hydralazine, MAO inhibitors, quinidine, ciprofloxacin, propafenone, oral contraeptives, fluoxetine, sertraline.
Decreased effect of metoprolol - NSAIDS, salycylates, barbiturates, rifampin, clonidine.
The dosage and frequency depend upon the individuals metabolism and the drug being used.
There are no substitutes to beta-blockers. There are no drugs to counteract the side effects of beta blockers.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

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