Mater Misericordiae University Hospital, Dublin, Ireland ; Leiden University Medical Center, Leiden, The Netherlands.
Eur Heart J Acute Cardiovasc Care. 2013 Mar;2(1):77-83. doi: 10.1177/2048872612471215.
Cardiotoxicity is a rare but serious complication of hydroxychloroquine, a 4-aminoquinoline increasingly used in the treatment of rheumatological disorders. We describe typical clinical, echocardiographic, and histological features of this rare condition according to the currently available literature, illustrated with a recent new biopsy-proven case of hydroxychloroquine cardiotoxicity in a 52-year-old female with rheumatoid arthritis. Presentation in this case was of a rapidly progressive decompensated biventricular cardiomyopathy associated with recurrent biomarker elevations, conduction system disease, and possibly neuromyotoxicity. Death occurred suddenly 2 months after diagnosis despite drug discontinuation and clinical improvement. The potential role of cardiac magnetic resonance delayed gadolinium enhancement imaging in the prognosis of this toxic cardiomyopathy is also introduced. This case-based literature review highlights that, although rare, hydroxychloroquine cardiotoxicity can be fatal, particularly if irreversible histopathological changes have occurred prior to drug discontinuation. Given this, regular screening with 12-lead electrocardiography and transthoracic echocardiography to detect conduction system disease and/or biventricular morphological or functional changes should be considered in hydroxychloroquine-treated patients in addition to recommended ophthalmological screening.
心脏毒性是羟氯喹的一种罕见但严重的并发症，羟氯喹是一种 4-氨基喹啉，越来越多地用于治疗风湿性疾病。根据现有文献，我们描述了这种罕见疾病的典型临床、超声心动图和组织学特征，并结合最近一例新的经活检证实的类风湿关节炎 52 岁女性羟氯喹心脏毒性病例进行说明。本例表现为迅速进展的双心室心力衰竭失代偿，伴有反复生物标志物升高、传导系统疾病，可能还有神经肌肉毒性。尽管停药和临床改善，但在诊断后 2 个月突然死亡。还介绍了心脏磁共振钆延迟增强成像在这种毒性心肌病预后中的潜在作用。基于病例的文献复习强调，尽管罕见，但羟氯喹心脏毒性可能是致命的，特别是如果在停药前已经发生不可逆转的组织病理学改变。鉴于此，除了推荐的眼科筛查外，还应考虑在接受羟氯喹治疗的患者中进行 12 导联心电图和经胸超声心动图常规筛查，以检测传导系统疾病和/或双心室形态或功能变化。
