Fig. 1.

HCQ, doxycycline, and the anti-acid mitigate CHF, and DCM, such as in aging, and viral myocarditis, caused by the chronic volume overload/preload. CHF instigates EE leakage and disrupts endothelial-endothelial, endothelial-myocyte, myocyte-myocyte and mitochondrial (Mito)-myocyte junctions. Activation of MMP-9 is the hallmark of CHF that disrupts connexin-37, and 43 leading to EE leakage, and DCM. HCQ, doxycycline, and anti-acid could help mitigate both CHF, and DCM. Abbreviations: HCQ; hydroxychloroquine, MMP-9; matrix metalloproteinase, EMMPRIN; extracellular matrix metalloproteinase inducer, CD-47; cluster of Differentiation 47