Question Dr. Fett - meds

[miachic]

I have read some interesting studies on how PPCM is thought to be an autoimmune response of the body. I have also read some of the same type of information about pre-e being an autoimmune response of the body. I also have other possible symptoms of autoimmune effects on my body, i.e. lots of eczema breakouts lately. (I am wondering if I've been building up to "the big one" over the last few years with all my eczema breakouts.)

Anyway, in reading all this, the question I have found some information about hydralazine having possible effects on the HLA antibodies in the body and that it can "trigger" or "exacerbate" any autoimmune response the body might be currently going through. Would the fact that I was put on hydralazine to lower my BP when I went into the hospital have anything to do with possibly exacerbating the beginning stages of PPCM? I have to wonder if this had an effect on how my body responded after delivery. If I was already having an autoimmune response with my pre-e and possible signs of PPCM (at this point EF was 40-45% with very mild global hypokinesis and slight enlargement of left ventricle), wouldn't the fact that I was on hydralazine point to the fact that it could have exacerbated that? I am just really curious about all this new information I've found on meds. I was also on mag sulfate, antibiotics for group B strep positive, Lasix to help diurese a little bit, Pitcon drip to induce labor and had two epidurals. Lots of stuff going into my body on top of my already complicated pregnancy.

Secondly, in regards to BB, since I had such a good response to them when I was on them a week PP and my BP went down (90s/50s), if I was put back on them with a "baseline" BP during the day of about 105/65, what would this do to my BP? Wouldn't it lower pretty significantly again? Also, would it have any effect on how much I can exercise? I have been using exercise as my "therapy" for this condition and I don't want to give it up for a few months until they regulate my dose. I really want to keep on exercising but wasn't sure how this would all have an effect on my BP response to exercise and stress on my heart. Would an ARB be better to be put on for my BP response? I read something on here from another lady who is on an ARB because of concerns about lowering BP too much.

Sorry so much detail. Just trying to get this all figured out. The HF doctor wasn't very helpful and wasn't very willing to discuss things with me. I'm hoping that at the FU visit she's more patient.

Emily

[JAMESFETT]

With the BB it is always a matter of individualizing dosages and building up to tolerance. In most cases, startiing low and sticking with it will do the job. ARB's are more expensive generally, and should not be considered as a substitute for BB, at best they are a sub for ACE-I. Some work has shown hydralazine to be helpful to suppress pro-inflammatory cytokines, which are involved in the development of inflammatory cardiomyopathy; so if anything, hydralazine would be helpful, not harmful. Our data from Haiti also shows favorable results with the use of hydralazine (when we were avoiding ACE-I in breast-feeding mothers), but harder to tolerate than ACE-I. When we realized the essential role of ACE-I in PPCM, the extremely small amount in breast milk, and the fact that the majority of PPCM mothers were so ill they lost their breast milk supply, we then routinely went to the use of ACE-I in all PPCM patients. You may indeed be a person more susceptible to an autoimmune disease or diseases. It is quite clear (to me) that the best conventional treatment of PPCM should include both ACE-I and BB.

JD

[miachic]

Thanks for your reply!

Emily