Correct!
4. 1 and 3
Beta blockers are relatively contraindicated and nondihydropyridine calcium channel blockers are contraindicated mainly because of the decrease in heart rate (3). The heart rate is the only mechanism that maintains cardiac output given the already decreased stroke volume from the restrictive cardiomyopathy. Nondihydropyridine calcium channel blockers are contraindicated also because this drug binds to amyloid fibrils with risk of hypotension and syncope (3). Angiotensin converting enzymes are also relatively contraindicated because these drugs may lower blood pressure and significantly increase the already existing risk for orthostatic hypotension (3).
Amyloid cardiomyopathy is treated with sodium restriction and diuretics which is challenging with restrictive cardiomyopathies. Typically, a combination of loop diuretics and an aldosterone antagonist is most effective. Beta blockers may need to be used for rate control in atrial fibrillation. Anticoagulation needs to be considered even with normal sinus rhythm with poor atrial function and atrial fibrillation given the high risk of thromboembolic complications. Defibrillators are controversial but may be warranted in certain situations.
How do you treat primary cardiac amyloidosis? (Click on the correct answer to proceed to the seventh and final page)