Clozapine-induced hypersensitivity myocarditis presenting as sudden cardiac death.

Katta, Natraj; Balla, Sudarshan; Aggarwal, Kul

doi:10.4322/acr.2016.054

Cited by 15 publications

(8 citation statements)

References 28 publications

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“…As demonstrated by Katta et al [70], CIM myocarditis may have the character of eosinophilic myocarditis. However, in contrast to other subtypes of eosinophilic myocarditis (such as in the course of the Churg-Strauss syndrome or hypereosinophilic syndrome), in myocarditis released by a hypersensitive reaction to clozapine, eosinophilia is observed in only about 62% of patients.…”

Section: Objawy I Przebieg Cim Oraz Wyniki Badań Dodatkowychmentioning

confidence: 87%

“…Jak wskazują Katta i wsp. [70] zapalenie mięśnia sercowego typu CIM może mieć charakter eozynofilowego zapalenia mięśnia sercowego. W przeciwieństwie do innych podtypów eozynofilowego zapalenia mięśnia sercowego (takich jak w przebiegu zespołu Churga-Strauss czy zespołu hipereozynofilowego), w zapaleniu mięśnia sercowego wyzwolonemu przez reakcję nadwrażliwości na klozapinę eozynofilię obserwuje się jedynie u około 62% pacjentów.…”

Section: Objawy I Przebieg Cim Oraz Wyniki Badań Dodatkowychunclassified

“…W przypadkach CIM biopsja endomiokardium (endomyocardial biopsy -EMB) wykazuje obecność nacieku komórkowego w obrębie mięśnia sercowego i martwicę kardiomiocytów [73,77]. Wśród komórek naciekających mięsień sercowy można zaobserwować eozynofile, makrofagi, limfocyty, komórki plazmatyczne, granulocyty [58,70,[78][79][80]. W warunkach fizjologicznych populacja eozynofili w obrębie mięśnia sercowego jest nieliczna, w związku z tym stwierdzenie skupiska tych komórek upoważnia do rozpoznania zapalenia eozynofilowego [81].…”

Section: Objawy I Przebieg Cim Oraz Wyniki Badań Dodatkowychunclassified

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Clozapine-induced myocarditis

Jahołkowski¹,

Mierzejewski²,

Świtaj³

2019

ppn

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Purpose: Presentation of the current state of knowledge on the epidemiology, pathogenesis, clinical picture, diagnosis and treatment of clozapine-induced myocarditis (CIM). Views: Clozapine is widely used in patients with psychotic disorders for whom previous therapy was inadequate or not tolerated. However, in some cases its use may be associated with serious side-effects. In addition to agranulocytosis, ketoacidosis and intestinal obstruction, CIM is the most serious and potentially life-threatening complication of clozapine therapy, as it encompasses the inflammation and injury of the heart muscle. Attempts to estimate the incidence of CIM are characterized by a large discrepancy of results. To date, the pathomechanism of CIM has not been well investigated. The variability of the clinical spectrum and the lack of pathognomonic signs significantly hinder diagnosis, which is usually based on clinical symptoms, echocardiography, concentration of troponin and C-reactive protein in the serum samples and, in some cases, by myocardial biopsy and cardiac magnetic resonance imaging. In patients with suspected/confirmed CIM, the main recommendation is to discontinue clozapine and monitor the patient's vital signs. Clinical observations indicate that a β-blocker and/or angiotensin-converting enzyme inhibitor might be useful in at least same cases of CIM. Conclusions: We point out that patients receiving clozapine should be carefully monitored for the symptoms of CIM. The publication contains guidelines for dealing with suspected CIM.

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Section: Objawy I Przebieg Cim Oraz Wyniki Badań Dodatkowychmentioning

confidence: 87%

Section: Objawy I Przebieg Cim Oraz Wyniki Badań Dodatkowychunclassified

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Clozapine-induced myocarditis

Jahołkowski¹,

Mierzejewski²,

Świtaj³

2019

ppn

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“…Возникновение жизнеугрожающих побочных эффектов отмечено также и при приеме терапевтических доз препарата. Среди них значимое место занимают неблагоприятные кардиальные эффекты, такие как миокардиты, кардиомиопатии, перикардиты, сердечная недостаточность, внезапная сердечная смерть [7][8][9][10][11]. A. Al-Wahab и соавт.…”

Section: Introductionunclassified

“…Occurrence of life-threatening side effects was also noted during intake of therapeutic doses of the drug. An important role among them belongs to adverse cardiac effects such as myocarditis, cardiomyopathy, pericarditis, heart failure, sudden cardiac death [7][8][9][10][11]. A. Al-Wahab et al revealed in an experimental study the increased levels of noradrenaline, adrenaline, troponins, creatine phosphokinase-MB, interleukins, tumor necrosis factor alpha, cytokines in the blood of mice that received Clozapine [12,13].…”

Section: Introductionmentioning

confidence: 99%

Morphological and Functional Alterations of the Cardiovascular System during Acute Clozapine Poisoning (Experimental Study)

Babkina

Рыжков

Antonova

et al. 2019

Obŝaâ reanimatologiâ

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Purpose of the study. To evaluate the influence of sublethal dose of Clozapine on the functional and morphological parameters of the cardiovascular system in rats 4 hrs. after the drug administration.Materials and methods. The experiments were carried out on male Wistar rats weighing 200–250g (n=14). Group I received 0.9% NaCl solution administered via enteral feeding tubing under general anesthesia using Sevoflurane; group II — Clozapine dosed at 150 mg/kg in 0.9% NaCl solution; group III — Clozapine dosed at 150 mg/kg in 40% ethyl alcohol solution. 4 hrs. after drug administration, arterial blood pressure (ABP), heart rate (HR), microcirculation in the skin using laser Doppler flowmetry (LSF), fluorescence intensity of coenzymes NADH and FAD were evaluated. After euthanasia, autopsy including withdrawal of the internal organs of rats for morphological analysis was performed. Thereafter, paraffin sections of hearts were made and subsequently stained with hematoxylin and eosin, which were later examined with the help of light microscope Nikon Eclipse Ni-U.Results. In both Clozapine groups, ABP and blood flow in the skin were lower than in the control group: ABP — by 12% in group I and by 15% in group II; blood flow — by 48% and 37%, respectively. No significant difference between the groups was observed in respect of the microcirculation indices studied. Increased fluorescence intensity of coenzyme NADH in the skin was found in the Clozapine groups compared to the control group (2.3-fold in group I and 1.9-fold in group II). Histological analysis of the hearts of animals that received Clozapine established uneven blood filling, erythrocyte sludges, fine-focal hemorrhaging, endotheliocyte nuclei oriented perpendicular to the basal membrane, uneven staining of myocardium with hypereosinophilic segments, fragmentation and undulating deformity of muscle fibers.Conclusion. During acute Clozapine poisoning, morphological signs of disturbed circulation and myocardium damage are found in the heart, which are accompanied with development of myocardium dysfunction with arterial hypotension and decreased peripheral blood flow, also disturbed oxidative metabolism in peripheral tissues.

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Giant Cell and Hypersensitivity Myocarditis

Gonzalez

Cooper

2020

Myocarditis

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Clozapine-induced hypersensitivity myocarditis presenting as sudden cardiac death.

Cited by 15 publications

References 28 publications

Clozapine-induced myocarditis

Clozapine-induced myocarditis

Morphological and Functional Alterations of the Cardiovascular System during Acute Clozapine Poisoning (Experimental Study)

Giant Cell and Hypersensitivity Myocarditis

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