Revisiting cardiac safety of hydroxychloroquine in rheumatological diseases during COVID-19 era: Facts and myths

Padiyar, Shivraj; Danda, Debashish

doi:10.5152/eurjrheum.2020.20174

Cited by 1 publication

(2 citation statements)

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“…This potential cardiotoxicity should be interpreted in the context that patients with COVID-19 may have a predisposition to developing arrhythmias ranging from sinus tachycardia, sinus bradycardia, and asystole secondary to the inflammatory process from COVID-19 (Fig. 2A ) [ 29 , 30 , 32 ]. Specifically, myocarditis is an important manifestation of COVID-19 disease that is pro-arrhythmogenic and the administration of QT prolonging medications may further exacerbate this underlying arrhythmia burden [ 30 ].…”

Section: Adverse Effectsmentioning

confidence: 99%

“…HCQ/ CQ can act as Vaughan-William Class-Ia anti-arrhythmic, similar to quinidine, and as such they have been implicated with conduction disorders, bradycardia, tachycardia, T-wave flattening, and QT interval prolongation [28]. The COVID-19 pandemic brought this into further focus as the potential for cardiotoxicity through QT prolongation was a critical consideration during clinical trials [29][30][31]. This potential cardiotoxicity should be interpreted in the context that patients with COVID-19 may have a predisposition to developing arrhythmias ranging from sinus tachycardia, sinus bradycardia, and asystole secondary to the inflammatory process from COVID-19 (Fig.…”

Section: Electrophysiological Effects Of Hydroxychloroquine On the Heartmentioning

confidence: 99%

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Review of Hydroxychloroquine Cardiotoxicity: Lessons From the COVID-19 Pandemic

Gagnon

Sadasivan

Yogasundaram

et al. 2022

Curr Heart Fail Rep

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Purpose of Review The coronavirus disease 2019 (COVID-19) pandemic has popularized the usage of hydroxychloroquine and chloroquine (HCQ/CQ) as treatments for COVID-19. Previously used as anti-malarial and now commonly used in rheumatologic conditions, preliminary in vitro studies have demonstrated these medications also have anti-viral properties. Retinopathy and neuromyopathy are well recognized complications of using these treatments; however, cardiotoxicity is under-recognized. This review will discuss the implications and cardiotoxicity of HCQ/CQ, their mechanisms of action, and their utility in COVID-19. Recent Findings Early clinical trials demonstrated a modest benefit of HCQ in COVID-19, causing a push for the usage of it. However, further large multi-center randomized control centers, demonstrated no benefit, and even a trend towards worse outcomes. The predominant cardiac complication observed with HCQ in COVID-19 was cardiac arrhythmias and prolonging of the QT interval. However, with chronic usage of HCQ/CQ, the development of heart failure (HF) and cardiomyopathy (CM) can occur. Summary Although, most adverse cardiac events related to HCQ/CQ usage in COVID-19 were secondary to conduction disorders given the short duration of treatment, HCQ/CQ can cause CM and HF, with chronic usage. Given the insufficient evidence, HCQ/CQ usage in COVID-19 is not routinely recommended, especially with novel therapies now being developed and used. Additionally, usage of HCQ/CQ should prompt initial cardiac evaluation with ECG, and yearly monitoring, with consideration for advanced imaging if clinically warranted. The diagnosis of HCQ/CQ cardiomyopathy is important, as prompt cessation can allow for recovery when these changes are still reversible.

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