Hamilton Steven, Tauseen Rana A, Wasef Natale, Wolf Andreas
Internal Medicine, Jersey Shore University Medical Center/Saint Francis Medical Center Program, Trenton, USA.
Cardiology, Mercer Bucks Cardiology/Saint Francis Medical Center, Trenton, USA.
Cureus. 2022 Jul 24;14(7):e27202. doi: 10.7759/cureus.27202. eCollection 2022 Jul.
Schizoaffective disorder, bipolar type is a chronic mental health disorder that may manifest as mania. Clozapine is effective in treating acute mania and in achieving mood stabilization. However, on rare occasions, the use of clozapine has been associated with cardiotoxicity. Here, we present a case of a 31-year-old man who at baseline is known to have schizoaffective disorder, bipolar type, and cannabis dependence and was admitted to our hospital with a psychotic relapse. He was treated with clozapine, uptitrated to a maximum daily dose of 200mg twice daily by day 10. Thereafter he became febrile and experienced malaise, myalgias, and chest pain. He was noted on electrocardiogram to have sinus tachycardia without ischemic changes. In this context, he had a troponin leak, increased white blood cell count, serologies and cultures were negative and chest x-ray revealed no acute disease of the chest. Due to the suspicion of clozapine-induced cardiotoxicity, a transthoracic echocardiogram was done, which revealed mildly depressed left ventricular (LV) systolic function without pericardial effusion. Thereafter, clozapine was withdrawn and switched to lithium. Additionally, the cardioselective, metoprolol tartrate was initiated. Within 36-48 hours, he had resolution of symptoms and remained cardiovascularly stable. Clozapine uncommonly causes cardiotoxicity and early features may be non-specific. Awareness of this and recognizing early features aids in reducing the associated cardiovascular morbidity and mortality.
双相型分裂情感性障碍是一种可能表现为躁狂的慢性精神健康障碍。氯氮平对治疗急性躁狂和实现情绪稳定有效。然而，在极少数情况下，氯氮平的使用与心脏毒性有关。在此，我们报告一例31岁男性病例，该患者基线时已知患有双相型分裂情感性障碍和大麻依赖，因精神病复发入院。他接受了氯氮平治疗，到第10天时剂量逐渐增加至最大每日剂量200mg，每日两次。此后，他出现发热，并伴有不适、肌痛和胸痛。心电图显示窦性心动过速，无缺血性改变。在此情况下，他出现肌钙蛋白泄漏，白细胞计数增加，血清学检查和培养均为阴性，胸部X线检查未发现胸部急性疾病。由于怀疑是氯氮平引起的心脏毒性，进行了经胸超声心动图检查，结果显示左心室（LV）收缩功能轻度降低，无心包积液。此后，停用氯氮平并换用锂盐。此外，开始使用心脏选择性的酒石酸美托洛尔。在36 - 48小时内，他的症状得到缓解，心血管状况保持稳定。氯氮平引起心脏毒性的情况不常见，早期症状可能不具有特异性。对此有所认识并识别早期症状有助于降低相关的心血管发病率和死亡率。
