Heart transplantation in a patient with chloroquine-induced cardiomyopathy

Freihage, Jeffrey H.; Patel, Nilamkumar; Jacobs, William R.; Picken, Maria M.; Fresco, Raoul; Malinowska, Krystyna; Pisani, Barbara; Méndez, José; Lichtenberg, Robert; Foy, Bryan K.; Bakhos, Mamdouh; Mullen, G. M.

doi:10.1016/s1053-2498(03)00108-6

Cited by 24 publications

(30 citation statements)

References 6 publications

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“…22,23 Prognosis in antimalarial cardiotoxicity can vary from death to cardiac transplantation to partial or complete improvement in cardiac function. 5,7,8,10,11,[13][14][15][16][17][18][19][20][24][25][26] Two case reports have described successful orthotopic heart transplantation. 7,10 Indication in both cases was refractory congestive heart failure 3 months after drug discontinuation.…”

Section: Discussionmentioning

confidence: 99%

“…5,7,8,10,11,[13][14][15][16][17][18][19][20][24][25][26] Two case reports have described successful orthotopic heart transplantation. 7,10 Indication in both cases was refractory congestive heart failure 3 months after drug discontinuation. In the review by Costedoat-Chalumeau et al, 7 of the 25 congestive heart failure cases described, death occurred in 11 (46%) and partial or complete improvement was seen in eight out of 12 cases where the drug was discontinued.…”

Section: Discussionmentioning

confidence: 99%

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Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Joyce

Fabre

Mahon

2012

European Heart Journal: Acute Cardiovascular Care

140

126

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Joyce

Fabre

Mahon

2012

European Heart Journal: Acute Cardiovascular Care

140

126

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“…To date, reports have been published on 35 patients with biopsy-proven cardiomyopathy 7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36 and on 30 patients with total AV block only 9,30,37,38 . Moreover, 12 of those patients with cardiomyopathy exhibited complete AV block as well (Table 1).…”

Section: Rheumatologymentioning

confidence: 99%

“…The prognosis for patients with this cardiomyopathy appears to be mixed: heart transplants had to be performed in 2 patients with refractory heart failure 9,22 . Thirteen patients died (most of them soon after the diagnosis was established).…”

Section: Rheumatologymentioning

confidence: 99%

Cardiomyopathy Caused by Longterm Treatment with Chloroquine: A Rare Disease, or a Rare Diagnosis?

Tönnesmann¹,

Stroehmann²,

Kandolf³

et al. 2012

J Rheumatol

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“…However, rare but severe toxic effects may develop following prolonged use of these treatments. These side effects include retinopathy, toxic neuropathy, vacuolar myopathy and/or cardiotoxicity [1] with both heart conduction disturbances [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29] and congestive heart failure (CHF) [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,30,31,32,33]. These cardiac toxic effects, described both singly or in combination, have been reported with CQ [1,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28, 30, 31] and less frequently with HCQ use alone [1,2,3,4, 29, 32, 33].…”

Section: Introductionmentioning

confidence: 99%

Cardiomyopathy Related to Antimalarial Therapy with Illustrative Case Report

Costédoat-Chalumeau¹,

Hulot

Amoura³

et al. 2006

Cardiology

106

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The antimalarial agents, chloroquine (CQ) and hydroxychloroquine (HCQ) are used in long-term treatment of connective tissue diseases and dermatological disorders and are generally regarded as safe. We present one case of cardiotoxicity in a 59-year-old woman treated with antimalarials during 13 years for a discoid lupus erythematosus. She progressively developed conduction disturbances and congestive heart failure (CHF). When the diagnosis of antimalarials toxicity was suspected, CQ was withdrawn. However, heart transplantation had to be performed in the following 4 months for severe CHF. Indeed, rare but severe cardiotoxicity may develop following prolonged use of antimalarials with both conduction disturbances (45 patients) and CHF (25 patients). These cardiac toxic effects have been reported with CQ and less frequently with HCQ use alone. Diagnoses are often delayed since the toxicity of the drug might be misattributed to other factors in these patients. The endomyocardial biopsy, or in some cases the muscle biopsy, are essential to confirm the antimalarials toxicity. Antimalarials have been stopped in 12 cases of CHF, leading to improvement in 8 cases (within 3 months to 5 years) and to deaths or to heart transplantation in 4 cases (within 1 week to 3 months). In the latter cases, as in our patient, the lack of improvement may have been explained by the severity of the cardiomyopathy at diagnosis and the short delay since withdrawal. As a consequence, the potential for reversibility and the severity in undiagnosed cases of these toxic cardiomyopathies emphasize the importance of recognizing early signs of toxicity in order to withdraw antimalarials before the occurrence of life-threatening CHF.

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Heart transplantation in a patient with chloroquine-induced cardiomyopathy

Cited by 24 publications

References 6 publications

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

Cardiomyopathy Caused by Longterm Treatment with Chloroquine: A Rare Disease, or a Rare Diagnosis?

Cardiomyopathy Related to Antimalarial Therapy with Illustrative Case Report

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