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Heart failure
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===Medications=== A number of medications may cause or worsen the disease. This includes [[nonsteroidal anti-inflammatory drug|NSAIDs]], [[COX-2 inhibitor]]s, a number of [[anesthetic]] agents such as [[ketamine]], thiazolidinediones, some [[Cancer#Medication|cancer medications]], several [[antiarrhythmic agent|antiarrhythmic medications]], [[pregabalin]], [[alpha-2 adrenergic receptor agonist]]s, [[minoxidil]], [[itraconazole]], [[cilostazol]], [[anagrelide]], [[stimulant]]s (e.g., [[methylphenidate]]), [[tricyclic antidepressant]]s, [[lithium (medication)|lithium]], [[antipsychotic]]s, [[dopamine agonist]]s, [[TNF inhibitor]]s, [[calcium channel blocker]]s (especially [[verapamil]] and [[diltiazem]]<ref name="pmid30165516">{{cite journal |vauthors=Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, etal | title=2018 ESC/ESH Guidelines for the management of arterial hypertension. | journal=Eur Heart J | year= 2018 | volume= 39 | issue= 33 | pages= 3021β3104 | pmid=30165516 | doi=10.1093/eurheartj/ehy339 | pmc= | doi-access=free }}</ref><ref name="pmid31668726">{{cite journal |vauthors=Suchard MA, Schuemie MJ, Krumholz HM, You SC, Chen R, Pratt N, etal | title=Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis. | journal=Lancet | year= 2019 | volume= 394 | issue= 10211 | pages= 1816β1826 | pmid=31668726 | doi=10.1016/S0140-6736(19)32317-7 | pmc=6924620 }}</ref>), [[salbutamol]], and [[tamsulosin]].<ref name="PageAHA">{{cite journal | vauthors = Page RL, O'Bryant CL, Cheng D, Dow TJ, Ky B, Stein CM, Spencer AP, Trupp RJ, Lindenfeld J | title = Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association | journal = Circulation | volume = 134 | issue = 6 | pages = e32β69 | date = August 2016 | pmid = 27400984 | doi = 10.1161/CIR.0000000000000426 | doi-access = free }}</ref> By inhibiting the formation of [[prostaglandin]]s, NSAIDs may exacerbate heart failure through several mechanisms, including promotion of fluid retention, increasing [[systemic vascular resistance|blood pressure]], and decreasing a person's response to diuretic medications.<ref name="PageAHA"/> Similarly, the ACC/AHA recommends against using COX-2 inhibitor medications in people with heart failure.<ref name="PageAHA"/> Thiazolidinediones have been strongly linked to new cases of heart failure and worsening of pre-existing congestive heart failure due to their association with weight gain and fluid retention.<ref name="PageAHA"/> Certain calcium channel blockers, such as [[diltiazem]] and [[verapamil]], are known to [[Inotrope#Negative inotropic agents|decrease the force with which the heart ejects blood]], thus are not recommended in people with heart failure with a reduced ejection fraction.<ref name="PageAHA"/> Breast cancer patients are at high risk of heart failure due to several factors.<ref>{{cite journal | vauthors = Lenneman CG, Sawyer DB | title = Cardio-Oncology: An Update on Cardiotoxicity of Cancer-Related Treatment | journal = Circulation Research | volume = 118 | issue = 6 | pages = 1008β1020 | date = March 2016 | pmid = 26987914 | doi = 10.1161/CIRCRESAHA.115.303633 }}</ref> After analyzing data from 26 studies (836,301 patients), the recent meta-analysis found that breast cancer survivors demonstrated a higher risk heart failure within first ten years after diagnosis (hazard ratio = 1.21; 95% CI: 1.1, 1.33).<ref name="Galimzhanov_2003">{{cite journal | vauthors = Galimzhanov A, Istanbuly S, Tun HN, Ozbay B, Alasnag M, Ky B, Lyon AR, Kayikcioglu M, Tenekecioglu E, Panagioti M, Kontopantelis E, Abdel-Qadir H, Mamas MA | title = Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis | journal = European Journal of Preventive Cardiology | volume = 30 | issue = 18 | pages = 2018β2031 | date = December 2023 | pmid = 37499186 | doi = 10.1093/eurjpc/zwad243 | doi-access = free }}</ref> The pooled incidence of heart failure in breast cancer survivors was 4.44 (95% CI 3.33-5.92) per 1000 person-years of follow-up.<ref name="Galimzhanov_2003"/>
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