Treating the Brain But Forgetting the Heart: Mitral Valvular Disease Cabergoline Induced

Abstract

Drug induced valvular heart disease is a forgotten entity of valvular disease, sometimes underdiagnosed or even misdiagnosed. The majority of drugs found to induce this kind of disease have a common pharmacological action on a specific serotonin receptor-the 5HT2B receptor. The typical echocardiographic features in these cases are mild to moderate thickening and restriction of the valve with no commissural fusion nor calcification which is the main cause of valvular regurgitation. These findings are not coherent with rheumatic valvular disease We described a case of a 36years old female with a past medical history of hyperprolactinemia treated with low dose of cabergoline for 9 months, presenting for dyspnea on minimal exertion and palpitation. She consulted a cardiologist that discovered a systodiastolic loud murmur on apical area. A cardiac ultrasound was done revealing a mitral valve disease with moderate leaflet thickening and restriction with no commissural fusion nor calcification with a severe eccentric mitral regurgitation grade 3+ due to tenting and malcoaptation of the valve during diastole. Rheumatic and degenerative valve disease were ruled out. The final diagnosis was a drug induced valvular heart disease and more specifically a cabergoline induced mitral valve disease acting on the serotonin receptors 5HT2B. Patient was sent for surgery. Early diagnosis with a good physical examination and current echocardiographic follow up in patient with hyperprolactinemia with even low dose of cabergoline and short term treatment is suggested.