Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
ESC Heart Fail. 2018 Jun;5(3):372-375. doi: 10.1002/ehf2.12276. Epub 2018 Feb 20.
Chloroquine (CQ) and hydroxychloroquine (HCQ) are anti-rheumatic medications frequently used in the treatment of connective tissue disorders. We present the case of a 45-year-old woman with CQ-induced cardiomyopathy leading to severe heart failure. Electrocardiographic abnormalities included bifascicular block, while structural disease consisted of severe biventricular and biatrial hypertrophy. Appropriate diagnosis via endomyocardial biopsy led to cessation of CQ and subsequent dramatic improvement in symptoms and structural heart disease. Cardiac toxicity is an under-recognized adverse effect of CQ/HCQ leading to cardiomyopathy with concentric hypertrophy and conduction abnormalities, with the potential for significant morbidity and mortality. Predisposing factors for CQ/HCQ-induced cardiomyopathy have been proposed. CQ/HCQ cardiomyopathy is a phenocopy of Fabry disease, and α-galactosidase A polymorphism may account for some heterogeneity of disease presentation.
氯喹（CQ）和羟氯喹（HCQ）是常用于治疗结缔组织疾病的抗风湿药物。我们报告了一例 CQ 诱导性心肌病导致严重心力衰竭的 45 岁女性患者。心电图异常包括双束支阻滞，而结构疾病包括严重的双心室和双心房肥大。通过心内膜心肌活检进行适当的诊断导致停止使用 CQ，随后症状和结构性心脏病显著改善。心脏毒性是 CQ/HCQ 的一种被低估的不良反应，可导致心肌病伴向心性肥厚和传导异常，具有显著的发病率和死亡率。已经提出了 CQ/HCQ 诱导性心肌病的易患因素。CQ/HCQ 心肌病是法布瑞病的表型，α-半乳糖苷酶 A 多态性可能解释了疾病表现的一些异质性。
