Taneja Anil K, Wong Jonathan, Bayliss John
Department of Medicine, Hemel Hempstead Hospital, Hemel Hempstead HP2 4AD, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.09.2008.0958. Epub 2009 Mar 17.
A man in his 30s presented with symptoms of shortness of breath (SOB). He was on clozapine for schizophrenic symptoms. From the initial two presentations it was thought to be and managed as a chest infection, and a perfusion ventilation scan was done to rule out pulmonary embolism. However, with worsening SOB on exertion, he presented for a third time, and was referred and seen in the Department of Medicine on this occasion. The ECG showed evidence of left atrial and ventricular enlargement. The chest x ray showed an increased cardiothoracic ratio. An urgent echocardiogram showed the presence of dilated cardiomyopathy with severe left ventricular systolic function impairment. The patient had a coronary angiogram and other relevant investigations to look for the cause of the dilated cardiomyopathy. These investigations did not reveal any significant abnormality. The cause appeared to be related to the drug clozapine. The patient was treated for heart failure, and clozapine was stopped. He improved and repeat echocardiogram at follow-up showed a definite improvement in the symptoms and the echocardiogram.
一名30多岁的男性出现呼吸急促症状。他因精神分裂症症状正在服用氯氮平。从最初的两次就诊情况来看，被认为是胸部感染并按此进行治疗，还做了灌注通气扫描以排除肺栓塞。然而，随着运动时呼吸急促症状加重，他第三次前来就诊，此次被转诊至内科并接受诊治。心电图显示有左心房和心室扩大的迹象。胸部X光显示心胸比率增加。紧急超声心动图显示存在扩张型心肌病，伴有严重的左心室收缩功能损害。该患者进行了冠状动脉造影及其他相关检查以查找扩张型心肌病的病因。这些检查未发现任何明显异常。病因似乎与氯氮平药物有关。该患者接受了心力衰竭治疗，氯氮平停药。他的病情有所改善，随访时重复超声心动图显示症状和超声心动图结果都有明显改善。
