Drug Therapy in Dilated Cardiomyopathy and Myocarditis

The book Drug Therapy in Dilated Cardiomyopathy and Myocarditis is one of 11 volumes in a series of monographs on basic and clinical cardiology. It deals with the traditional, novel, and experimental pharmacologic agents used to treat congestive heart failure (CHF) and myocarditis, and with the relationship between these two disorders. The precise definition of dilated cardiomyopathy differs according to various authors. The preface of this book begins by defining this form of congestive heart failure and discussing its prevalence and possible etiologies. The editors state that dilated cardiomyopathy is defined as a state in which "both ventricles are enlarged, systolic function is reduced, and the coronary arteries are normal." They note a study by Johnson and Palacious which estimates that this form of congestive heart failure is 10 to 25 percent as common as ischemic cardiomyopathy and that dilated cardiomy-opathy is increasing in both prevalence and incidence. For this reason, they conclude that a book on the drug therapy for dilated cardiomyopathy is valuable. The book is divided into 15 chapters. The first three deal with the anatomy and pathophysiology of the failing heart. The next five deal with traditional methods of treatment, including digitalis, diuretics, and afterload-reducing agents. The next four chapters deal with drugs such as dobutamine, levadopa, and beta blockers, which are not yet used routinely to treat cardiomyopathies. The description of the pathophysiology of CHF is a nice review, but the next nine chapters on the forms of treatment are confusing. Many of the studies referred to in these chapters were studies in which ischemia was the major cause of CHF. Thus, these studies were not dealing with the dilated type of CHF which the editors profess to be reviewing. In the preface, the editors stressed the significance of this volume as a review of the pharmacologic therapy for non-ischemic dilated cardiomyopathy. In this respect, the book failed. Chapter 13, entitiled "Myocarditis as a cause of dilated cardiomyopathy," begins with the statement, "The hypothesis that myocarditis may be a cause, if not the major cause, of dilated (congestive) cardiomyopathy has been posed repeatedly, and over the years increasing evidence has been accumulated in its support." This statement further implies that the initial 12 chapters were describing a different entity. In any event, this chapter does provide interesting evidence that myocarditis may be a major cause of dilated cardiomyopathy. The following chapter discusses immunotherapy as a …