clozapine and Chest-Pain

Clozapine is an alternative antipsychotic medication used to control symptoms of schizophrenia and to reduce risks of suicidal behavior in patients who did not adequately respond to standard medication. Due to severe side effects including cardiomyopathy and myocarditis its clinical use is limited.. A 31-year-old man of east European descent presented to the emergency medical department with fatigue, shortness of breath and chest pain. Due to a schizoaffective disorder he was treated with clozapine and lithium. Echocardiography revealed severely impaired left ventricular systolic function. After exclusion of coronary artery disease by coronary angiography an endomyocardial biopsy was performed according to the guidelines. This confirmed the clinically suspected toxic cardiomyopathy. Therefore, antipsychotic treatment was immediately changed and state of the art heart failure medication was started resulting in a clear improvement of left ventricular function.. In patients treated with clozapine or lithium and clinical signs of heart failure, toxic cardiomyopathy should be considered.

Topics: Adult; Antipsychotic Agents; Biopsy; Cardiomyopathies; Chest Pain; Clozapine; Dyspnea; Echocardiography; Fatigue; Heart; Humans; Male; Myocardium; Psychotic Disorders; Treatment Outcome

Topics: Antipsychotic Agents; Chest Pain; Clozapine; Diagnostic Imaging; Echocardiography, Doppler; Electrocardiography; Humans; Magnetic Resonance Imaging; Myocarditis; Pericarditis, Constrictive; Young Adult

Topics: Adult; Antipsychotic Agents; Chest Pain; Clozapine; Heart Function Tests; Humans; Male; Myocarditis; Schizophrenia, Paranoid; Troponin; Ultrasonography; Violence

Clozapine is an atypical, neuroleptic medication that can cause myocarditis. While the "gold standard" for diagnosis of myocarditis is perceived to be via myocardial biopsy, cardiovascular magnetic resonance (CMR) has also proven its utility in this respect, primarily through its ability to detect myocardial scar by late-gadolinium enhancement (LGE). Until recently, however, clozapine-induced myocarditis specifically has not been known to be associated with LGE on CMR. In that particular case, LGE was demonstrated in a patient with clozapine-induced myocarditis. However, quite important, that patient also had specific abnormalities on the electrocardiogram (ECG) and echocardiogram that corresponded to the area of LGE demonstrated by CMR. We highlight a case series of three patients with clozapine-induced myocarditis and provide a literature review to discuss and critically appraise the true incremental diagnostic value of CMR in such patients with normal ECG and echocardiography.

Topics: Adolescent; Antipsychotic Agents; Cardiovascular Diseases; Chest Pain; Clozapine; Echocardiography; Electrocardiography; Humans; Magnetic Resonance Imaging; Male; Myocarditis; Schizophrenia

A 45-year-old woman of Moroccan origin developed a dilated cardiomyopathy during clozapine treatment for a psychosis that did not respond to conventional antipsychotics. The onset of her illness was acute with chest pain. She subsequently developed shortness of breath and oedema of the face and legs. The cardiomyopathy appeared to be partially reversible after the clozapine was halted. Cardiomyopathy during the use of clozapine is rarely described in the literature, although myocarditis is a known complication. The cause of cardiomyopathy during the use of clozapine is not known. Myocarditis might evolve into cardiomyopathy. There are indications that myocarditis is caused by an allergic reaction to clozapine. It is advised that clozapine treatment should only be initiated under the close supervision of a psychiatrist, and that during the use of clozapine one should be alert to the risk of cardiac complications.

Topics: Acute Disease; Antipsychotic Agents; Cardiomyopathy, Dilated; Chest Pain; Clozapine; Edema; Female; Humans; Middle Aged; Remission Induction