Are all CCBs contraindicated in patients with LV systolic dysfunction?
Welcome to cardiac dilutions let’s see our quote today amlodipine is contraindicated in lv systolic dysfunction is that true or false our colleague is seeing a patient at the opc as he is a 47 year old male who had an average blood pressure of 160 over 90 despite taking velcro 10 160 milligram once per day piso prolol 10 milligram once per day and hydrochlorocytes
25 milligram once per day so he wants to add amlodipine as a calcium char blocker to assist in blood pressure control but is concerned as a patient has a recent echo with an estimated ejection fraction of 35 percent so he had lv systolic dysfunction because he had anterior stemi six months ago and so he had persistent lv storage function after the procedure
And another colleague in the clinic told him don’t give calcium channel blockers a patient with healthy stomach dysfunction they are absolutely contraindicated so what shall our colleague do shall he give calcium char blocker or avoid them totally let’s revise calcium chain blockers briefly we know that we have calcium channels on the cell membrane of cardiac
Muscle fibers and also the cells of sa node av node and conductive tissue and they are responsible for calcium influx into the cytoplasm to assist in depolarization of the sa node and av node and also to assess the muscle contraction of the cardiac muscle fibers so we have a family of medications called calcium channel blockers which come to block the calcium
Channels in order to inhibit transmembrane calcium influx this action is produced in the vascular smooth muscles resulting in vasodilator effects and also on the myocardium resulting in negative inotropic effect as here it depresses the contractility of the myocardium plus conductive system resulting in negative chronotropic as it decreases heart rate and negative
Dromotropic effect as it slows down the conduction velocity we have two subtypes of calcium channel blockers the dihydrobiothene family like the famous amlodipine plus my philippine philodepine and lyr canadipine and the non-dhb like the famous barapamil and deltaism dhb act mainly on the vascular smooth muscle cells more than the heart resulting in predominantly
Vasodilator effects whereas non-dhb act predominantly on the heart resulting in negative inotropic chronotropic and dromotropic effects rather than vasodilator effects that’s why the main indication of dhb cats and child blockers is in hypertension whereas non-php are used mainly in patients with tachyarrhythmias or patients with hypertrophic cardiomyopathy and lvot
Obstruction so based on this information which group is contraindicated in patients with lv systolic dysfunction like heart failure with mid-range ejection fraction or reduced ejection fraction of course non-dhb due to their negative inotropic they are absolutely contraindicated and systolic dysfunction and that’s why in the 2016 ec guidelines of heart failure there
Was a clear class 3 recommendation to avoid deltaism or varapamil in patients with heart failure with reduced ejection fraction still the same contraindication in 2021 guidelines but the clear recommendation was in 2016. and which group is contraindicated in patients with breathy arrhythmias also it is varapamil and deltaism due to their negative chronotropic and
Dromotropic effects so it is clear now that non-dhb are contraindicated in lv systolic dysfunction and brady arrhythmias what about dhp catsam china blockers can we use them in patients with heart failure with reduced ejection fraction or mid-range ejection fraction for a purpose of controlling blood pressure and the 2018 ac guidelines for hypertension there were
Clear recommendations regarding the therapeutic strategy in patients with hypertension and heart failure and regarding the choice of medication those class one indication to use ace inhibitor or angiotensin receptor blocker for blood pressure control in patients with heart failure plus using a beta blocker and a diuretic or mineralocorticoid receptor antagonist
Because here this medication are not used only for blood pressure control but also for mortality benefit as a patient here has heart failure and there was class 2b to use dhp consumption blockers if blood pressure control cannot be achieved despite using the previous medication so the hp calcium chain blockers were not contraindicated in patients with hypertension
And heart failure but they are not the first choice as the previously mentioned medications so if calcium channel blockers were one of the first medication to be chosen in any patient with hypertension without comorbidities in patients with heart failure the priority are for rest blockers beta blockers and diuretics and if still not controlled we can resort to
Calcium channel blockers the 2021 ac guidelines for heart failure tackled this issue as he mentioned that uncontrolled hypertension is rare in patients with heart failure and reduce ejection fraction if the patient is taking an optimized medical treatment at the recommended doses however sometimes the patient may need further antihypertensives if blood pressure is
Not controlled and so in absence of signs of fluid overloads we can add amlodipine or philodepine as they have been shown to be safe in patients with heart failure and so they may be considered what about the non-dhb cathamtrani blockers and centrally acting antihypertensives they are still contraindicated in these cases and regarding alpha brokers they have no
Effect on survival and so they are not indicated but sometimes we can use them if the patient has concomitant prostatic hyperplasia but to be withdrawing if the patient develops hypotension so if you want to summarize the recommendations to choose antihypertensives in patient with heart failure so priority of course is for rest blockers beta blockers and diuretics
And if the patient’s still having uncontrolled blood pressure at the time we can use dhp calcium shard blockers especially amlodipine or philodepene so if one of your colleagues told you that amlidipine and other dhp cascam channel blockers are contraindicated in lv systolic dysfunction of course you should tell him that only non-dhb cat subscribe blockers are
Contraindicated in lv systolic dysfunction and we can use dhps in patients with heart failure with reduced or mid-range ejection fraction for blood pressure control but after having an optimized medical treatment at target doses and so they can be used but they are not the first choice they are the last resorts thank you very much for watching this video and wait
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Transcribed from video
Cardiac Delusions: Amlodipine in HF (English Version) By CardioMinds Dr. Sherif AltoukhyliveBroadcastDetails{isLiveNowfalsestartTimestamp2022-03-19T170011+0000endTimestamp2022-03-19T171211+0000}