Cohen Ronny, Lysenko Alla, Mallet Thierry, Mirrer Brooks, Gale Michael, Loarte Pablo, McCue Robert
Chief of Cardiology, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA.
Pharmacy Department, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA.
Case Rep Cardiol. 2015;2015:283156. doi: 10.1155/2015/283156. Epub 2015 Aug 30.
We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB). An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine) versus acute coronary syndrome. He was managed conservatively and transferred to another facility for endomyocardial biopsy confirming myocarditis. This case is an example of one of the most typical presentations of suspected drug-induced acute myocarditis and will hopefully prompt the reader to think of this underdiagnosed entity in the right clinical setting.
我们报告一例药物性心肌炎病例，该病例表现为一名患有双相情感障碍且正在接受抑郁症治疗的年轻患者出现急性心力衰竭。该病例描述了一名20岁男性，在精神科病房接受治疗，因抑郁症病情恶化，开始抱怨胸痛和呼吸急促。他的用药清单包括氯氮平、锂盐、劳拉西泮和氟哌啶醇。体格检查的主要发现为心动过速、低热、听诊双肺底部有湿啰音，且无明显水肿。实验室检查异常包括肌钙蛋白为0.9，肌酸激酶（CK）为245，肌酸激酶同工酶（CK-MB）为3.1。心电图显示窦性心动过速和左前分支阻滞（LAFB）。超声心动图显示整体运动减弱，严重左心室功能障碍，射血分数估计为20%。该患者入院诊断为急性左心室收缩功能障碍，可能继发于药物性心肌炎（怀疑为氯氮平）与急性冠状动脉综合征。他接受了保守治疗，并被转至另一机构进行心内膜心肌活检，确诊为心肌炎。该病例是疑似药物性急性心肌炎最典型的表现之一，有望促使读者在正确的临床环境中考虑到这个诊断不足的疾病。
