Myositis & the Heart: New Perspectives on the Pathogenesis & Management of Cardiac Involvement in Myositis

Regarding cardiac-specific therapies, Dr. Zakaria clarified that no specific studies have tested these therapies in patients with autoimmune myopathies. If the patient has evidence of heart failure, his first-line treatment is diuretic therapy. If there is evidence of obstructive coronary artery disease, he refers patients for potential intervention.

After this, he considers therapies to treat heart failure, including angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blocker (ARB) therapy.¹¹ A beta blocker may also be prescribed to support favorable cardiac remodeling in a stable patient. Dr. Zakaria also recommended aldosterone antagonist therapy. If these therapies are ineffective, he moves to advanced therapy, including the consideration of ventricular assist devices, heart transplant or, more likely, palliative care.

Dr. Zakaria reiterated the value of diagnostics in identifying the extent of cardiac involvement when a patient with myositis is referred to a cardiologist. After the disease state and effects are understood, he stressed how close collaboration with the patient’s rheumatologist is critical to establishing therapies proven to increase cardiac function.

Carina Stanton is a freelance science journalist based in Denver.

References

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