Ventricular tachyarrhythmia in a 78-year-old woman with essential thrombocythaemia

Abstract

Anagrelide is a phosphodiesterase-3 inhibitor used in the treatment of essential thrombocythaemia. Cardiovascular side effects such as ventricular tachycardia and cardiomyopathy are rare but potentially fatal and should be made known to patients before starting the medication. It usually arises within the first 6 months after initiation of therapy and may be dose related. The elderly population are particularly susceptible. These cardiotoxicities result from an increase in cyclic AMP that induces positive inotropic and chronotropic effects and are often reversible with cessation of use. We report a case of a 78-year-old woman with essential thrombocythaemia and recently started on anagrelide who presented with syncope and multiple bruises and facial trauma and found to have developed ventricular tachyarrhythmia.

Anagrelide-Induced Supraventricular Tachycardia: A Case Report

“…However, PDE3 inhibition also leads to increased intracellular levels of cyclic AMP and intracellular calcium in the cardiac myocytes, which in turn enhances inotropy and chronotropy. These effects can be cardiotoxic by manifesting as arrhythmias [ 6 , 7 ], cardiomyopathy [ 8 , 9 ], and heart failure [ 10 , 11 ]. This side effect profile appears to be dose-related and more pronounced in the elderly population.…”

Anagrelide-associated Cardiomyopathy and Heart Failure in a Patient with Essential Thrombocythemia: A Case Report and Literature Review

“…Cardiovascular complications, such as blood pressure changes, palpitations, tachycardia, arrhythmia, fluid retention, congestive heart failure, and angina pectoris, are the major adverse effects induced by anagrelide (1)(2)(3). It is also involved in rare but significant cardiac diseases that can potentially cause heart failure (HF), including acute coronary syndrome, coronary spastic angina, ventricular tachycardia, cardiac dysfunction, and inverted takotsubo syndrome (4)(5)(6)(7)(8).…”