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Medication

Medication Summary

Ebstein anomaly requires drug treatment for cardiovascular consequences resulting from tricuspid atrialization of the right ventricle, valvular regurgitation, and septal defects. Patients may require antibiotic prophylaxis for bacterial endocarditis. Treatment of SVT is typically by radiofrequency ablation rather than drug therapy. CHF is treated with ACE inhibitors, diuretics, and digoxin.

Class Summary

These agents promote excretion of water and electrolytes by the kidneys. They are used in treatment of hypertension, heart failure, and hepatic, renal, or pulmonary disease when salt and water retention has resulted in edema or ascites.

Furosemide (Lasix)

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Increases excretion of water by interfering with chloride-binding cotransport system, which in turn inhibits sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule. Dose must be individualized. Depending on response, administer at increments of 20-40 mg no sooner than 6-8 h after previous dose until desired diuresis occurs. When treating infants, titrate with 1 mg/kg/dose increments until satisfactory effect achieved.

Class Summary

These agents possess positive inotropic activity, which is mediated by inhibition of sodium-potassium adenosine triphosphatase (Na⁺/K⁺ ATPase). Also, cardiac glycosides reduce conductivity in the heart, particularly through the atrioventricular node, and therefore have a negative chronotropic effect. The cardiac glycosides have very similar pharmacological effects but differ considerably in their speed of onset and duration of action. They are used to slow the heart rate in supraventricular arrhythmias, especially atrial fibrillation, and also are administered in chronic heart failure.

Digoxin (Lanoxin, Lanoxicaps)

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Cardiac glycoside with direct inotropic effects in addition to indirect effects on cardiovascular system. Acts directly on cardiac muscle, increasing myocardial systolic contractions. Its indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

Class Summary

ACE inhibitors are beneficial in all stages of chronic heart failure. Dyspnea and exercise tolerance are improved. Unlike diuretics, studies demonstrate improvement of survival and reduced progression of mild or moderate heart failure to more severe stages. They have benefit in asymptomatic left ventricular dysfunction.

Enalapril (Vasotec)

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Competitive inhibitor of ACE. Reduces angiotensin II levels, decreasing aldosterone secretion.

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Author

Kamran Riaz, MD Clinical Assistant Professor, Department of Internal Medicine, Section of Cardiology, Wright State University, Boonshoft School of Medicine

Kamran Riaz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Society of Echocardiography, Ohio State Medical Association, Royal College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Marschall S Runge, MD, PhD Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine

Marschall S Runge, MD, PhD is a member of the following medical societies: American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Texas Medical Association, Southern Society for Clinical Investigation, American Federation for Clinical Research, Association of Professors of Medicine, Association of Professors of Cardiology, American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Medical Research, American Heart Association

Disclosure: Received honoraria from Pfizer for speaking and teaching; Received honoraria from Merck for speaking and teaching; Received consulting fee from Orthoclinica Diagnostica for consulting.

Chief Editor

Yasmine S Ali, MD, MSCI, FACC, FACP Assistant Clinical Professor of Medicine, Vanderbilt University School of Medicine; President, LastSky Writing, LLC

Yasmine S Ali, MD, MSCI, FACC, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Medical Writers Association, National Lipid Association, Tennessee Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: MCG Health;LastSky Writing;Philips Healthcare;Corvidane;M Health;GE Healthcare;Athena Health;PeerView Institute;Verywell Health;HealthCentral;MedEdicus;Pharmaceutical Training Institute;Elsevier;MedStudy;North American Thrombosis Forum;HealthTuition.

Additional Contributors

Park W Willis IV, MD Sarah Graham Distinguished Professor of Medicine and Pediatrics, University of North Carolina at Chapel Hill School of Medicine

Park W Willis IV, MD is a member of the following medical societies: American Society of Echocardiography

Disclosure: Nothing to disclose.

Ebstein Anomaly Medication

Medication Summary

Diuretics

Class Summary

Furosemide (Lasix)

Furosemide (Lasix)

Cardiac glycosides

Class Summary

Digoxin (Lanoxin, Lanoxicaps)

Digoxin (Lanoxin, Lanoxicaps)

Angiotensin-converting enzyme inhibitors

Class Summary

Enalapril (Vasotec)

Enalapril (Vasotec)

Ebstein Anomaly Medication

Medication Summary

Diuretics

Class Summary

Furosemide (Lasix)

Furosemide (Lasix)

Cardiac glycosides

Class Summary

Digoxin (Lanoxin, Lanoxicaps)

Digoxin (Lanoxin, Lanoxicaps)

Angiotensin-converting enzyme inhibitors

Class Summary

Enalapril (Vasotec)

Enalapril (Vasotec)

References

Tables

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