# Cardiomyopathy - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-09 ## Verified against - 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 ## Treatment metadata - Referral & safety-netting (no drug therapy) - Enalapril — 5 mg — oral.solid - Bisoprolol — 2.5 mg — oral.solid - Carvedilol — 6.25 mg — oral.solid - Spironolactone — 25 mg — oral.solid - Furosemide — 40 mg — oral.solid ## Complete treatment card ```text CARDIOMYOPATHY 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) Review status: REVIEWED against 4 sources listed above (2026-09) 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 Source StatPearls "Dilated Cardiomyopathy" - disease-level clinical article Status 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 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 Peds Children follow the same pathway: recognise and refer. Heart-failure medicines for a child are paediatric cardiology decisions, not primary-care ones. 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. Caution 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 [1st line] Adult 2.5 mg BID initially, titrate to target 10-20 mg BID - long-term Peds Specialist pediatric cardiology management required 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. Caution 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. Egypt ACAPRIL 5 MG 10 TAB. ALFACURE PHAR... 6.75 EGP (0.68/unit) PRESSLIGHT 5 MG 10 TAB. EL-OBOUR 7.00 EGP (0.70/unit) RENITEC 5MG 28 TAB. GLOBAL NAPI P... 30.60 EGP (1.09/unit) BETA-BLOCKER - choose one 3. BISOPROLOL [1st line] Adult 1.25 mg once daily, titrate slowly (doubling every 2+ weeks) to target 10 mg once daily - long-term Peds 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. 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. Caution 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. Egypt BISTOL 2.5MG 20 F.C.TAB. HIKMA PHARMA 28.00 EGP (1.40/unit) BISOLOCK 2.5 MG 30 F.C.TABS. PHARCO 48.00 EGP (1.60/unit) BISOCARD 2.5 MG 30 F.C.TAB. GLOBAL NAPI P... 51.00 EGP (1.70/unit) NORMOCARD 2.5 MG 30 TAB. PHARMA CURE 51.00 EGP (1.70/unit) CONCOR COR 2.5 MG 30 F.C. TABS. AMOUN > MERCK... 60.00 EGP (2.00/unit) 4. CARVEDILOL [1st line] Adult 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 Peds Effectiveness in patients under 18 years has not been established. 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. Caution 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. Egypt VIDILOL 6.25 MG 10 TABS. MEMPHIS 3.50 EGP (0.35/unit) CARLOL-V 6.25MG 30 F.C.TAB AMOUN 19.50 EGP (0.65/unit) KARVEX 6.25MG 30 TAB. SIGMA 19.50 EGP (0.65/unit) CARDILOL 6.25MG 30 TAB. MARCYRL PHARM... 39.00 EGP (1.30/unit) CARVID 6.25MG 20 TAB. MULTI-APEX 30.00 EGP (1.50/unit) CARVID 6.25MG 30 TAB. MULTI-APEX 45.00 EGP (1.50/unit) DILATROL 6.25MG 30 TAB. CHEMIPHARM 48.00 EGP (1.60/unit) CARVIPRESS 6.25MG 20 SCORED TAB. GLOBAL NAPI P... 13.00 EGP MINERALOCORTICOID ANTAGONIST 5. SPIRONOLACTONE [1st line] Adult 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 Peds Specialist paediatric cardiology management. The formulary's paediatric spironolactone doses are for oedema, hypertension and primary aldosteronism, not for HFrEF. 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. Caution 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. Egypt SPIRONOLACTONE (DELTA) 25MG 10 TAB. GLOBAL NAPI PHARMACEUTIC... 3.00 EGP (0.30/unit) EPILACTONE 25MG 10 TAB. EIPICO 4.00 EGP (0.40/unit) POTASAVE 25 MG 20 TAB. ALFACURE PHAR... 11.00 EGP (0.55/unit) ALDACTONE 25MG 20 TAB KAHIRA > SEAR... 18.00 EGP (0.90/unit) POTASPIRONO 25 MG 20 TAB. UNIPHARMA 36.00 EGP (1.80/unit) SPECTONE 25 MG 20 TABS. KAHIRA 36.00 EGP (1.80/unit) CONGESTION - give alongside 6. FUROSEMIDE [add-on - not a substitute] Adult 20-40 mg once daily in the morning (or divided BID), titrate based on fluid overload and symptom response - long-term Peds Specialist pediatric cardiology management required 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. Caution 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. Egypt ODEMENT 40MG 10 TAB. EL NASR 1.30 EGP (0.13/unit) FRUZEX 40MG 12 TAB. MISR 3.25 EGP (0.27/unit) FUROSEMIDE 40MG 20 TAB. SEDICO 7.50 EGP (0.38/unit) FURORETIC 40 MG 30 TABS. DEBEIKY > VET... 14.25 EGP (0.47/unit) LAFUREX 40MG 20 TAB. AMOUN 9.50 EGP (0.47/unit) SALEX 40 MG 20 TABS. ARAB DRUG COM... 10.00 EGP (0.50/unit) FUROSEMIDE-ALEX 40MG 20 TAB. ALEXANDRIA 19.00 EGP (0.95/unit) LASIX 40 MG 24 TABS. SANOFI 30.00 EGP (1.25/unit) GENESEMIDE 20MG/5ML SYRUP 120 ML MEDIZEN PHARM... 56.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)