Dawaa Reference

chronic

Cardiomyopathy

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources7 sources

Hypertrophic Cardiomyopathy - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK430788/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD72.02 - condition scope only, no dose · ESC Guidelines for Heart Failure 2021 · Egyptian National Drug Formulary - Cardiovascular 2024 (carvedilol monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph) · UK eMC Furosemide 20 mg Tablets SmPC, product id 14911 · Cardiomyopathy - disease-level clinical article (cardiomyopathy-clinical.txt)

Verified against5 documents
  • Cardiomyopathy - disease-level clinical article (cardiomyopathy-clinical.txt)
  • ESC Guidelines for Heart Failure 2021
  • Egyptian National Drug Formulary - Cardiovascular 2024 (carvedilol monograph)
  • Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph)
  • UK eMC Furosemide 20 mg Tablets SmPC, product id 14911

Verified date2026-09

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (2)

  • A long asymptomatic latent period is common before left ventricular systolic dysfunction produces symptoms
  • Nonspecific fatigue, malaise, and weakness may occur; severe cases can bring thromboembolism, conduction disturbance, arrhythmia, or sudden cardiac death [arrhythmia · fatigue · malaise · sudden cardiac arrest]

Signs — what you find (4)

  • Heart-failure findings: crackles in the lungs, elevated JVP, peripheral edema, and an S3 gallop [crackles · leg swelling · raised JVP]
  • The point of maximum impulse is classically displaced laterally
  • Tricuspid or mitral regurgitant murmurs are common from ventricular enlargement and annular dilation
  • Neck exam may show jugular venous distension, an A-wave, large V waves, and a positive hepatojugular reflux [raised JVP]

Tests (7)

  • Workup screens for reversible causes first: thyroid function, HIV serology, electrolytes, and iron studies for hemochromatosis
  • A low BNP helps rule out CHF and also carries prognostic weight
  • Chest x-ray can show cardiomegaly with pulmonary effusion and venous congestion; ECG can show nonspecific ST/T changes or atrial fibrillation
  • A peak oxygen consumption under 14 ml/kg/min signals a poor prognosis
  • Echocardiography is the key diagnostic study, assessing ventricular size and function, valve abnormalities, and mural thrombus, and separating DCM from hypertrophic or restrictive disease
  • Coronary angiography is performed when CAD history is absent, to rule out occult ischemia as the cause
  • Myocardial biopsy is rarely needed and reserved for suspected storage or infiltrative disease, since idiopathic DCM histology is nonspecific

If not this — what else fits (2)

  • Cardiac tamponade and acute pericarditis
  • Hypertrophic and restrictive cardiomyopathy

SourceStatPearls "Dilated Cardiomyopathy" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Renin-angiotensin blocker | Beta-blocker | Mineralocorticoid antagonist | Congestion

MAIN TREATMENT

1

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

A structural heart-muscle disease needing echocardiography and cardiology follow-up; a GP may co-manage heart-failure symptoms with standard medication while arranging specialist review. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. Heart-failure medicines for a child are paediatric cardiology decisions, not primary-care ones.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

A structural heart-muscle disease needing echocardiography and cardiology follow-up; a GP may co-manage heart-failure symptoms with standard medication while arranging specialist review.

Cautions
  • RED FLAG - Sustained ventricular tachycardia / palpitations: assess urgently and refer.
  • Syncope, family history of sudden cardiac death, signs of decompensated heart failure, arrhythmia.
  • Referral for echocardiography and cardiology follow-up is the pathway. Heart-failure medicines treat the syndrome alongside it; disease-specific therapy is decided by the service referred to.
  • RED FLAG - Workup for reversible secondary causes (thyroid, HIV, iron overload, substance abuse) must be pursued prior to diagnosing idiopathic DCM.
  • RED FLAG - Patients with DCM refractory to maximum medical therapy require evaluation for advanced therapies such as LVAD or cardiac transplantation.

RENIN-ANGIOTENSIN BLOCKER

2

ENALAPRIL

Renin-angiotensin blocker

1st line

Strength5 mg

Formoral.solid

Adult dose and duration

2.5 mg BID initially, titrate to target 10-20 mg BID - long-term

Paediatric dose

Specialist pediatric cardiology management required

Dose source

ESC Guidelines for Heart Failure 2021

Why

Dilated cardiomyopathy with reduced ejection fraction is treated as HFrEF. The disease article recommends an ACE inhibitor or ARB in these patients (cardiomyopathy-clinical.txt); the dose is the one carried on the Heart failure card.

Cautions
  • CONTRAINDICATED in pregnancy.
  • Check serum creatinine and potassium within 1-2 weeks of initiation.
  • Caution in renal artery stenosis or eGFR < 30 mL/min.
  • If a RAAS agent cannot be used at all, the article offers a combination that is not listed above: "For patients with HFrEF and intolerance to RAASI or in whom RAASI is contraindicated due to renal insufficiency, the use of a combination of hydralazine and nitrate might be effective."
  • Hydralazine is not offered for heart failure here. The Egyptian formulary indicates it for "Hypertension, chronic: Management of moderate to severe hypertension." only, states no heart-failure dose anywhere, and contraindicates it outright: "Cardiovascular disease: Use is contraindicated in patients with coronary artery disease (CAD)." - adding that "myocardial stimulation produced by hydralazine can cause anginal attacks and electrocardiogram (ECG) changes of myocardial ischemia; has been implicated in the production of myocardial infarction." Ischaemic heart disease is the commonest cause of heart failure, so that contraindication is not a rare edge case.
  • An SGLT2 inhibitor and an ARNI are also part of modern HFrEF therapy. The cardiomyopathy article does not name them; the Heart failure card carries both with their doses.
Egyptian brands
Egyptian brandManufacturerIndicative price
ACAPRIL 5 MG 10 TAB.ALFACURE PHARMACEUTICALS6.75 EGP (0.68/unit)
PRESSLIGHT 5 MG 10 TAB.EL-OBOUR7.00 EGP (0.70/unit)
RENITEC 5MG 28 TAB.GLOBAL NAPI PHARMACEUTICALS > MERCK SHARP & DOHME30.60 EGP (1.09/unit)

BETA-BLOCKER - choose one

3

BISOPROLOL

Beta-blocker

1st line

Strength2.5 mg

Formoral.solid

Adult dose and duration

1.25 mg once daily, titrate slowly (doubling every 2+ weeks) to target 10 mg once daily - long-term

Paediatric dose

Specialist pediatric cardiology management required

Choice

Sourced preference carried from the Heart failure card: the Egyptian formulary names bisoprolol the beta-blocker of choice for heart failure with reduced ejection fraction. The cardiomyopathy article itself ranks no beta-blocker above another.

Dose source

ESC Guidelines for Heart Failure 2021

Why

The disease article recommends beta-blockade for all patients with reduced ejection fraction and no contraindication, naming bisoprolol (cardiomyopathy-clinical.txt); the dose is the one carried on the Heart failure card.

Cautions
  • CONTRAINDICATED in acute decompensated heart failure or cardiogenic shock.
  • Avoid in severe asthma or second/third-degree AV block.
  • Monitor blood pressure, heart rate, and fluid status during titration.
  • An SGLT2 inhibitor and an ARNI are also part of modern HFrEF therapy. The cardiomyopathy article does not name them; the Heart failure card carries both with their doses.
Egyptian brands
Egyptian brandManufacturerIndicative price
BISTOL 2.5MG 20 F.C.TAB.HIKMA PHARMA28.00 EGP (1.40/unit)
BISOLOCK 2.5 MG 30 F.C.TABS.PHARCO48.00 EGP (1.60/unit)
BISOCARD 2.5 MG 30 F.C.TAB.GLOBAL NAPI PHARMACEUTICALS51.00 EGP (1.70/unit)
NORMOCARD 2.5 MG 30 TAB.PHARMA CURE51.00 EGP (1.70/unit)
CONCOR COR 2.5 MG 30 F.C. TABS.AMOUN > MERCK KGAA F.R.GERMANY60.00 EGP (2.00/unit)
4

CARVEDILOL

Beta-blocker

1st line

Strength6.25 mg

Formoral.solid

Adult dose and duration

3.125 mg twice daily initially, doubled at intervals of at least 2 weeks as tolerated. Maximum 25 mg twice daily if 85 kg or less or in severe heart failure; 50 mg twice daily if over 85 kg - Long-term

Paediatric dose

Effectiveness in patients under 18 years has not been established.

Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (carvedilol monograph)

Why

The disease article recommends beta-blockade for all patients with reduced ejection fraction and no contraindication, naming carvedilol (cardiomyopathy-clinical.txt); the dose is the one carried on the Heart failure card.

Cautions
  • Use one beta-blocker only - carvedilol and bisoprolol are alternatives to each other, never given together.
  • CONTRAINDICATED in bronchial asthma, acute or decompensated heart failure requiring intravenous inotropes, second- or third-degree AV block, severe bradycardia without a pacemaker, sick sinus syndrome, cardiogenic shock and severe hepatic disease.
  • Expect transient worsening of symptoms and hypotension in the first 2 weeks - warn the patient, do not abandon the drug, and increase the diuretic temporarily if needed.
  • Never start during an acute decompensation and never stop abruptly.
  • Avoid in severe hepatic impairment; moderate impairment may need a dose reduction.
  • Masks the adrenergic warning signs of hypoglycaemia in an insulin-treated patient.
  • An SGLT2 inhibitor and an ARNI are also part of modern HFrEF therapy. The cardiomyopathy article does not name them; the Heart failure card carries both with their doses.
Egyptian brands
Egyptian brandManufacturerIndicative price
VIDILOL 6.25 MG 10 TABS.MEMPHIS3.50 EGP (0.35/unit)
CARLOL-V 6.25MG 30 F.C.TABAMOUN19.50 EGP (0.65/unit)
KARVEX 6.25MG 30 TAB.SIGMA19.50 EGP (0.65/unit)
CARDILOL 6.25MG 30 TAB.MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)39.00 EGP (1.30/unit)
CARVID 6.25MG 20 TAB.MULTI-APEX30.00 EGP (1.50/unit)
CARVID 6.25MG 30 TAB.MULTI-APEX45.00 EGP (1.50/unit)
DILATROL 6.25MG 30 TAB.CHEMIPHARM48.00 EGP (1.60/unit)
CARVIPRESS 6.25MG 20 SCORED TAB.GLOBAL NAPI PHARMACEUTICALS13.00 EGP

MINERALOCORTICOID ANTAGONIST

5

SPIRONOLACTONE

Mineralocorticoid antagonist

1st line

Strength25 mg

Formoral.solid

Adult dose and duration

12.5-25 mg once daily, adjusted every 4 weeks if potassium and kidney function are stable, to a maximum of 50 mg/day - long-term

Paediatric dose

Specialist paediatric cardiology management. The formulary's paediatric spironolactone doses are for oedema, hypertension and primary aldosteronism, not for HFrEF.

Dose source

Egyptian National Drug Formulary - Cardiovascular 2024 (spironolactone monograph)

Why

The disease article recommends aldosterone receptor blockade with spironolactone in NYHA class II-IV with systolic dysfunction (cardiomyopathy-clinical.txt); the dose is the one carried on the Heart failure card.

Cautions
  • Given WITH the beta-blocker, the ACE inhibitor and the SGLT2 inhibitor, not instead of any of them - NICE offers all four.
  • Check potassium and creatinine before starting, at 1 and 4 weeks after each dose change, then regularly. Stop if potassium exceeds 6.0 mmol/L.
  • Avoid the combination of spironolactone with an ACE inhibitor plus a potassium supplement or a potassium-containing salt substitute - that is the classic route to a fatal potassium.
  • Painful gynaecomastia in men is common and is the usual reason for stopping.
  • The heart failure dose is 25 mg. The ascites dose is 100 mg. They are not interchangeable.
  • An SGLT2 inhibitor and an ARNI are also part of modern HFrEF therapy. The cardiomyopathy article does not name them; the Heart failure card carries both with their doses.
Egyptian brands
Egyptian brandManufacturerIndicative price
SPIRONOLACTONE (DELTA) 25MG 10 TAB.GLOBAL NAPI PHARMACEUTICALS > AL DELTA PHARMACEUTICALS TRADING CO.3.00 EGP (0.30/unit)
EPILACTONE 25MG 10 TAB.EIPICO4.00 EGP (0.40/unit)
POTASAVE 25 MG 20 TAB.ALFACURE PHARMACEUTICALS11.00 EGP (0.55/unit)
ALDACTONE 25MG 20 TABKAHIRA > SEARLE-CANADA18.00 EGP (0.90/unit)
POTASPIRONO 25 MG 20 TAB.UNIPHARMA36.00 EGP (1.80/unit)
SPECTONE 25 MG 20 TABS.KAHIRA36.00 EGP (1.80/unit)

CONGESTION - give alongside

6

FUROSEMIDE

Congestion

add-on - not a substitute

Strength40 mg

Formoral.solid

Adult dose and duration

20-40 mg once daily in the morning (or divided BID), titrate based on fluid overload and symptom response - long-term

Paediatric dose

Specialist pediatric cardiology management required

Dose source

UK eMC Furosemide 20 mg Tablets SmPC, product id 14911

Why

The disease article uses loop diuretics for hypervolaemia, and oral diuretics to hold a euvolaemic state in chronic stable disease (cardiomyopathy-clinical.txt); the dose is the one carried on the Heart failure card.

Cautions
  • Monitor electrolytes (potassium, sodium) and renal function regularly.
  • Caution in gout or severe hepatic impairment.
  • There is a risk of hypotension and hypovolaemia.
  • An SGLT2 inhibitor and an ARNI are also part of modern HFrEF therapy. The cardiomyopathy article does not name them; the Heart failure card carries both with their doses.
Egyptian brands
Egyptian brandManufacturerIndicative price
ODEMENT 40MG 10 TAB.EL NASR1.30 EGP (0.13/unit)
FRUZEX 40MG 12 TAB.MISR3.25 EGP (0.27/unit)
FUROSEMIDE 40MG 20 TAB.SEDICO7.50 EGP (0.38/unit)
FURORETIC 40 MG 30 TABS.DEBEIKY > VETOPHARM14.25 EGP (0.47/unit)
LAFUREX 40MG 20 TAB.AMOUN9.50 EGP (0.47/unit)
SALEX 40 MG 20 TABS.ARAB DRUG COMPANY (ADCO)10.00 EGP (0.50/unit)
FUROSEMIDE-ALEX 40MG 20 TAB.ALEXANDRIA19.00 EGP (0.95/unit)
LASIX 40 MG 24 TABS.SANOFI30.00 EGP (1.25/unit)
GENESEMIDE 20MG/5ML SYRUP 120 ML? strength differs? different route - not oral solidMEDIZEN PHARMACEUTICAL INDUSTRIES > VODACHEM56.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.