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Dilated cardiomyopathy: an unusual complication of clozapine therapy

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From Nature Clinical Practice Cardiovascular Medicine

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Abstract

Background A 42-year-old obese man presented with acute pulmonary edema. He had a history of chronic residual schizophrenia for which he had been taking clozapine for 7 years, but had no known prior cardiac disease. Echocardiography demonstrated severe biventricular systolic and diastolic dysfunction with severe left ventricular enlargement. Cardiac catheterization showed no coronary artery disease.

Investigations Physical examination, chest radiography, electrocardiography, transthoracic echocardiography, laboratory testing, viral serology, cardiac catheterization, coronary angiography and abdominal and renal ultrasonography.

Diagnosis Clozapine-induced dilated cardiomyopathy.

Management Intravenous nesiritide, furosemide and morphine followed by oral heart-failure therapy comprising ramipril, metoprolol succinate, spironolactone, and furosemide. Clozapine therapy was withdrawn.

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Figure 1: Transthoracic echocardiograms demonstrating severe left ventricular dysfunction and enlargement of the left ventricle.

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Authors and Affiliations

  1. B Makhoul is a Resident in the Department of Internal Medicine B, and ZS Azzam is a Specialist in Internal Medicine and Cardiology and the Acting Director of The Department of Internal Medicine B, I Hochberg is a Specialist in Internal Medicine and a Fellow in Endocrinology at the Institute of Endocrinology, Diabetes and Metabolism, S Rispler is a Specialist in Internal Medicine and Cardiology and an Attending Physician at The Heart Institute, all at the Rambam Health Care Campus, Haifa, Israel.,

    Badira Makhoul, Irit Hochberg, Shmuel Rispler & Zaher S Azzam

Authors
  1. Badira Makhoul
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  2. Irit Hochberg
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  3. Shmuel Rispler
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  4. Zaher S Azzam
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Corresponding author

Correspondence to Zaher S Azzam.

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The authors declare no competing financial interests.

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Makhoul, B., Hochberg, I., Rispler, S. et al. Dilated cardiomyopathy: an unusual complication of clozapine therapy. Nat Rev Cardiol 5, 566–570 (2008). https://doi.org/10.1038/ncpcardio1292

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  • DOI: https://doi.org/10.1038/ncpcardio1292

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