Layland Jamie J, Liew Danny, Prior David L
St Vincent's Hospital, Melbourne, VIC, Australia.
Med J Aust. 2009 Feb 16;190(4):190-2. doi: 10.5694/j.1326-5377.2009.tb02345.x.
Clozapine is a valuable drug for patients with treatment-resistant schizophrenia. Myocarditis is the most publicised cardiac complication of clozapine treatment, but cardiomyopathy and pericarditis have also been reported. Myocarditis has heterogeneous and non-specific presenting features, making it difficult to identify patients with clozapine-related myocarditis clinically. A high index of suspicion is required. The gold standard for diagnosis of myocarditis is an endomyocardial biopsy, but this is not a practical initial approach. Transthoracic echocardiography is a valuable, reproducible and widely available tool to assist in diagnosis of clozapine-induced cardiotoxicity. The level of B-type natriuretic peptide, a hormone secreted in response to ventricular wall stress, may be useful for evaluating patients with clozapine-induced cardiac dysfunction and may in the future be useful for screening asymptomatic patients. The mainstay of treatment of clozapine-induced cardiotoxicity is cessation of clozapine and provision of supportive care.
氯氮平对于难治性精神分裂症患者是一种有价值的药物。心肌炎是氯氮平治疗最广为人知的心脏并发症，但心肌病和心包炎也有报道。心肌炎具有异质性和非特异性的表现特征，使得临床上难以识别氯氮平相关性心肌炎患者。需要高度怀疑。心肌炎诊断的金标准是心内膜心肌活检，但这不是一种实用的初始方法。经胸超声心动图是一种有价值、可重复且广泛可用的工具，有助于诊断氯氮平引起的心脏毒性。B型利钠肽是一种响应心室壁压力而分泌的激素，其水平可能有助于评估氯氮平引起的心脏功能障碍患者，并且未来可能有助于筛查无症状患者。氯氮平引起的心脏毒性的主要治疗方法是停用氯氮平并提供支持性护理。
