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Beneficial effect of ivabradine in dilated cardiomyopathy from Becker muscular dystrophy

Positiver Effekt von Ivabradin bei dilatativer Kardiomyopathie durch Becker-Muskeldystrophie

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Abstract

Objectives

The I(f) blocker ivabradine reduces heart rate and improves systolic function without causing arterial hypotension. Ivabradine has not been reported to improve cardiac involvement in Becker muscular dystrophy (BMD).

Case report

In a 22-year-old Vietnamese male with BMD, cardiac involvement became apparent at age 19 years with reduced systolic function, which was treated with ramipril. At the age of 20 years, he developed sinus tachycardia, leg edema, coughing, and arterial hypotension. Dilated cardiomyopathy was diagnosed and ramipril was successfully replaced by candesartan, ivabradine, and furosemide. An attempt to discontinue ivabradine and increase candesartan was followed by recurrence of sinus tachycardia and reduction of blood pressure. Under ivabradine, candesartan, and spironolactone, which replaced furosemide, he achieved heart rates between 60 and 80 beats/min and systolic blood pressure values between 85 and 105 mmHg without heart failure.

Conclusion

Ivabradine normalizes sinus tachycardia and resolves heart failure in patients with dilated cardiomyopathy from BMD. In addition to normalization of the heart rate and remodeling of the left ventricle, ivabradine seems to also have a positive inotropic effect in dilated cardiomyopathy of BMD patients.

Zusammenfassung

Hintergrund

Der I(f)-Blocker Ivabradin vermindert die Herzfrequenz und verbessert die systolische Funktion, ohne dabei den Blutdruck zu senken. Eine Verbesserung der Herzbeteiligung bei Becker-Muskeldystrophie (BMD) durch Ivabradin wurde bisher nicht beschrieben.

Fallbericht

Bei einem 22-jährigen Vietnamesen mit BMD wurde die Herzbeteiligung an der neurologischen Erkrankung durch eine Verminderung der systolischen Funktion im 19. Lebensjahr manifest und mit Ramipril behandelt. Im Alter von 20 Jahren entwickelte er eine Sinustachykardie, Beinödeme, Husten und einen niedrigen arteriellen Blutdruck. Eine dilatative Kardiomyopathie wurde diagnostiziert und Ramipril erfolgreich durch Candesartan, Ivabradin, und Furosemid ersetzt. Der Versuch, Ivabradin zu beenden und Candesartan zu steigern, führte zu einem Wiederauftreten der Sinustachykardie und niedrigem Blutdruck, weswegen wieder auf Ivabradin, Candesartan und Spironolacton, welches Furosemid ersetzte, umgestellt wurde. Unter dieser Medikation konnten eine Herzfrequenz zwischen 60 und 80/min und systolische Blutdruckwerte zwischen 85 und 105 mmHg, ohne Herzinsuffizienz, erziehlt werden.

Schlussfolgerung

Ivabradin bringt eine Sinustachykardie und Herzinsuffizienz bei Patienten mit dilatativer Kardiomyopathie im Rahmen einer BMD zum Verschwinden. Zusätzlich zur Normalisierung der Herzfrequenz und Remodellierung des linken Ventrikels scheint Ivabradin einen positiv inotropen Effekt bei dilatativer Kardiomyopathie im Rahmen einer BMD zu haben.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Danube University Krems, Krems, Österreich

    J. Finsterer MD, PhD

  2. Krankenanstalt Rudolfstiftung, Vienna, Postfach 20, 1180, Vienna, Österreich

    J. Finsterer MD, PhD

  3. Medical Department, Krankenanstalt Rudolfstiftung, Vienna, Österreich

    C. Stöllberger

  4. Medical Department, Kaiser-Franz-Josef Spital, Vienna, Österreich

    E. Berger

Authors
  1. J. Finsterer MD, PhD
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  2. C. Stöllberger
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  3. E. Berger
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Correspondence to J. Finsterer MD, PhD.

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Finsterer, J., Stöllberger, C. & Berger, E. Beneficial effect of ivabradine in dilated cardiomyopathy from Becker muscular dystrophy. Herz 37, 702–705 (2012). https://doi.org/10.1007/s00059-012-3643-8

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  • DOI: https://doi.org/10.1007/s00059-012-3643-8

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