Importância da toxicidade pulmonar pela amiodarona no diagnóstico diferencial de paciente com dispnéia em fila para transplante cardíaco

Abstract

Amiodarone is a class III antiarrhythmic medication used extensively to treat ventricular arrhythmias. It is pharmacologically classified as a cationic amphiphilic drug due to its polar and apolar components. During the past few years, amiodarone has proved to be an effective treatment therapy for patients with ventricular dysfunctions, regardless of the etiology, and in particular ventricular arrhythmia associated with Chagas disease. Nevertheless, despite its hemodynamic and electrophysiological benefits, amiodarone produces serious collateral effects such as a bluish skin discoloration, photosensitivity, thyroid dysfunction, corneal deposit, peripheral neuropathy, bone marrow suppression, hepatitis, heart blocks, pneumonitis, among others. The objective of this case report is to discuss one of the most serious complications related to amiodarone, pulmonary toxicity, which is described as a differential diagnosis for a chagasic patient that was on the waiting list for a heart transplant. Amiodarone pneumonitis is a relevant differential diagnosis for heart failure (HF) patients using amiodarone that are admitted to the emergency ward with dyspnea.

II Consenso Brasileiro em Doença de Chagas, 2015

“…Toxicidade extracardíaca, disfunção tireoidiana e anormalidades dermatológicas não são incomuns, enquanto a toxicidade pulmonar grave é rara. 242 Recomenda-se, no mínimo, avaliação periódica da função tireoidiana em casos sob tratamento com amiodarona.…”

Clinical predictors of inducible sustained ventricular tachycardia during electrophysiologic study in patients with chronic Chagas' heart disease

“…Amiodarone use has been associated with several types of complications in Chagas' disease patients probably due to the chronically high dose. The complications include thyroid disease (hypo or hyperthyroidism) in 21% to 39% of cases [25], [26], restrictive pulmonary disease [27], ocular disease and gray-skin discoloration. A pro-arrhythmic effect secondary to chronic amiodarone use is supposed to have been occurred in one patient with chronic Chagas' heart disease [28].…”