Valvular Heart Disease in Pergolide-Treated Parkinson's Disease

Abstract

Pergolide is an ergot-derived dopamine agonist used in the treatment of Parkinson's disease (PD). Like other ergot derivatives, pergolide can be associated with fibrotic complications, including cardiac valvulopathy. Recent reports have indicated that these valvular changes may occur more commonly than initially recognized. The present case demonstrates how rapidly these changes can evolve in the setting of pergolide treatment. CASE REPORTA 61-year-old woman was admitted with a one year history of progressive dyspnea. There was no previous history of heart disease or other significant medical problems, except for PD diagnosed about seven years previously. At that time she was started on levodopa/carbidopa, which produced good symptom control for about three years, until end-of-dose deterioration developed. Pergolide was added and proved successful in regaining control of her Parkinson's symptoms. Parkinson's disease medications at the time of hospital admission consisted of controlled release levodopa/carbidopa 200/50, 1.5 tablets four times daily, and pergolide 1.75mg four times daily.Examination revealed a thin, anxious woman with signs of congestive heart failure, including a Grade III/VI pansystolic murmur ABSTRACT: Background: A 61-year-old woman with Parkinson's disease, receiving pergolide 1.75 mg four times daily, was admitted with progressive dyspnea. Methods: Investigations revealed mitral and aortic regurgitation. She underwent surgical mitral replacement and aortic repair, but had a postoperative course characterized by repeated bouts of congestive heart failure. Results: Severe tricuspid valve (TV) regurgitation developed within one month after the TV was reported on echocardiography to be relatively normal. Subsequent discontinuation of pergolide was associated with symptomatic improvement. Conclusions: This case illustrates the severity and rapidity with which cardiac valvular abnormalities can develop in patients receiving pergolide. CASE REPORTinvolving the entire precordium, and evidence of pulmonary and peripheral edema. There was mild symmetrical cogwheel rigidity in upper limbs, slight resting tremor of both hands, and bradykinesia for repetitive finger movements. In general, PD signs seemed well controlled.Cardiac investigations included transesophageal echocardiogram (TEE), which confirmed the presence of severe mitral valve (MV) regurgitation and moderate aortic valve (AV) insufficiency. The pulmonary and tricuspid valves (TV) were relatively normal, although mild TV regurgitation was noted. Surgical AV repair and MV replacement were undertaken, with the MV replaced by a mosaic bioprosthetic tissue valve. Intra-operatively, significant thickening of all https://www.cambridge.org/core/terms. https://doi

Dopamine agonists and valvular heart disease in patients with Parkinson's disease: evidence and mystery

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Dopamine agonists and valvular heart disease in patients with Parkinson's disease: evidence and mysterySince the first case report [28], further case reports [4,7,8,19,21,27,30], one observational report [2], case-control studies [12,17,18,[31][32][33][34], and one cohort study [26] conducted in PD patients have demonstrated similar findings of fibrotic VHD caused by ergot dopamine ag-JON 5012 ■ Abstract High doses of the ergot dopamine agonists, pergolide and cabergoline, frequently cause valvular regurgitation and, somewhat less frequently, valvular heart disease (VHD) in Parkinson's disease. Most patients with valvular regurgitation have no cardiac signs

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