A young man with acute dilated cardiomyopathy associated with methylphenidate

Abstract

An 18-year-old obese man with a body mass index of 40, diagnosed with attention-defi cit hyperactivity disorder and treated with methylphenidate (Concerta ® ) was acutely admitted to hospital with hypoxia and dyspnoea. On investigation signs of liver-, renal-, and heart-failure were found. Noradrenalin infusion was started. Echocardiography showed dilated left ventricle and an ejection fraction (EF) of 25%. Liver function improved, noradrenalin and dobutamine were tapered, but three days after admission a new echocardiography showed an EF of 10%. The patient was transferred to the National Hospital (Rikshospitalet, Oslo), where intensifi ed treatment including intra aortic balloon pump (IABP) was instituted. Cardiac function improved, and 3 weeks later the IABP was disconnected. EF at this point was 15%. The patient was denied heart transplantation due to various cofactors. The investigation concluded with a probable relationship between his cardiomyopathy and the use of methylphenidate (Concerta). Keywords: cardiomyopathy, heart failure, ADHD, methylphenidate Heart failure due to idiopathic dilated cardiomyopathy (DCM) is rare in young people. Case descriptionAn 18-year-old male was diagnosed with attention-defi cit hyperactivity disorder (ADHD) in 2005. He was overweight with a body mass index (BMI) of 40. He was started on quetiapine fumarate (Seroquel ® ) 900 mg daily in April 2005 and methylphenidate (Concerta ® ) 54 mg daily in September 2005. In the beginning of August 2006 he was admitted to his local hospital with severe dyspnoea, tachypnea, tachycardia, and cyanosis. On admission the blood pressure was 120/80 mmHg, and the arterial blood gas revealed a pH of 7.45, pCO2 of 3.55 kPa, paO2 of 7.76 kPa, and BE of −5.1 mmol/l. C-reactive protein was not elevated. The chest X-ray showed an enlarged heart. He developed hemoptysis and was treated with unfractionated heparin in suspicion of pulmonary embolism. He subsequently developed cardiogenic shock and was treated with vasoactive drugs. In spite of the treatment he became oliguric and his liver enzymes were rising. He was referred to our hospital for further treatment. On admission the blood pressure was 90/60 mmHg, despite infusion with noradrenaline. His heart rate was 130/minute and his temperature was 38.4 °C. A thoracic computed tomography scan did not show pulmonary embolism. Echocardiography revealed biventricular

Commentary on “A Case of Acute Cardiomyopathy and Pericarditis Associated with Methylphenidate”; Cardiovasc Toxicol, DOI 10.1007/s12012-009-9033-7

“…He developed ST elevation in EKG that was normalized with 36 h. Then, the authors mentioned association of cardiomyopathy and pericarditis with methylphenidate. This association was supported by the reports of previous studies [2,3].…”

“…The reference of Tollofsrud [3] was not in English and I could not study it. The second reference, the Nymark et al [2] reported a patient with body mass index of 40 who has taken quetiapine 900 mg/day for 17 months and methylphenidate was added. However, there is another report for possible association of cardiomyopathy and methamphetamine use in young patients [6].…”

Methylphenidate and Dyslipidemia

“…There are very few reports linking methylphenidate therapy to DCM. Two reports from Norway described serious cardiomyopathy in young patients treated with methylphenidate (20)(21). One of them was severly obese (BMI-40).…”

A Case of Acute Cardiomyopathy and Pericarditis Associated with Methylphenidate

“…Two recent cases from Norway described the development of dilated cardiomyopathy in young patients after years of methylphenidate use [5,6]. Treatment duration in one case was 1 year and in the other case 10 years [5,6]. To our knowledge, this is the first reported case of acute cardiomyopathy and myopericarditis associated with a single dose of methylphenidate.…”

“…However, to date there have been very few case reports linking methylphenidate to cardiomyopathy and even fewer linking methylphenidate to pericarditis. Two recent cases from Norway described the development of dilated cardiomyopathy in young patients after years of methylphenidate use [5,6]. Treatment duration in one case was 1 year and in the other case 10 years [5,6].…”