Therapy of RCM:
> Diuretics are used with caution to avoid inadvertent reduction of ventricular filling pressures. There may be also extreme sensitivity to beta blockers . ACEI/ARBs may also be used with caution.
> In amyloidosis, ACEIs and ARBs are rarely tolerated and may provoke profound hypotension, even when prescribed in small doses.
> Beta-blockade is of no proven use and may aggravate hypotension whereas calcium channel blockers generally worsen congestive heart failure.
> Digoxin is potentially arrhythmogenic, particularly in amyloidosis.
> Anticoagulation is recommended because of the propensity for thrombus formation in all types of RCM and particularly in endomyocardial fibrosis.
AF reduces cardiac output, and rhythm control is recommended.
> Permanent pacing and/or ICD may be required in conduction disturbances, sick sinus syndrome, and arrhythmias.
> Transplantation may increase survival, but, in systemic disorders, such as amyloidosis or sarcoidosis, recurrences may be seen in the transplanted heart.