Left ventricular systolic dysfunction precipitated by verapamil in cardiac amyloidosis.
Cardiac amyloidosis produces a restrictive cardiomyopathy with impaired diastolic function. We report a case in which low-dose verapamil resulted in marked worsening of congestive heart failure, as a result of a profound negative inotropic effect. Withdrawal of verapamil therapy demonstrated a return of systolic function to normal with improvement in heart failure. We postulate that patients with cardiac amyloidosis may be exceptionally sensitive to the negative inotropic effects of calcium-channel blockers either because of abnormal binding to amyloid fibrils or because their usual vasodilator effects are blunted.
Pollak
A
A
Department of Medicine, Boston City Hospital 02118.
Falk
R H
RH
D000686:Amyloidosis / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D002303:Cardiac Output, Low / Q000188:drug therapy / Q000209:etiology; D009202:Cardiomyopathies / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D006333:Heart Failure / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D013599:Systole; D016277:Ventricular Function, Left / Q000187:drug effects*; D014700:Verapamil / Q000009:adverse effects* / Q000627:therapeutic use
D014700:Verapamil