Cardiomyopathy Caused by Longterm Treatment with Chloroquine: A Rare Disease, or a Rare Diagnosis?

Tönnesmann, E; Stroehmann, I.; Kandolf, Reinhard; Wolburg, Hartwig; Strach, Katharina; Mußhoff, Frank; Tiemann, Klaus; Lewalter, Thorsten

doi:10.3899/jrheum.110959

Cited by 26 publications

(24 citation statements)

References 35 publications

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“…This impairs intracellular degradation and leads to accumulation of pathological metabolic products such as phospholipid and glycogen. 279,280 On histology, these appear as granulovacular cell mutations and ultrastructurally as lamellar membranous inclusion bodies and curvilinear bodies in the cytoplasm. Prognosis can vary from death to cardiac transplantation to partial or complete improvement within 1 month to 1 year on medication discontinuation.…”

Section: Antimalarial Agentsmentioning

confidence: 99%

“…Risk factors consist of older age, female sex, longer duration of therapy (3 months-27 years; mean >10 years), elevated milligram per kilogram daily dose, preexisting cardiac disease, and renal insufficiency. 279,280 Urological Medications α 1 -Blockers Limited data exist on the specific use of the uroselective (eg, tamsulosin) and nonuroselective (eg, prazosin, terazosin, doxazosin) α 1 -blockers in the management of benign prostatic hypertrophy for patients with HF. In the case of the nonuroselective agents, which have greater systemic α-blockade effects, much of the evidence has been extrapolated from the results of ALLHAT and Ve-HFT-1.…”

Section: Antimalarial Agentsmentioning

confidence: 99%

“…278 Cardiotoxicity manifests as restrictive or dilated cardiomyopathy or with conduction system abnormalities such as atrioventricular and bundle-branch block. 279,280 Because both chloroquine and hydroxychloroquine are cationic amphiliphilic drugs, they are hypothesized to bind to phospholipids within the myocyte, accumulating in the lysosomes and inhibiting lysosomal enzymes. This impairs intracellular degradation and leads to accumulation of pathological metabolic products such as phospholipid and glycogen.…”

Section: Antimalarial Agentsmentioning

confidence: 99%

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Drugs That May Cause or Exacerbate Heart Failure

Page¹,

O’Bryant²,

Cheng³

et al. 2016

Circulation

322

163

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Heart failure is a common, costly, and debilitating syndrome that is associated with a highly complex drug regimen, a large number of comorbidities, and a large and often disparate number of healthcare providers. All of these factors conspire to increase the risk of heart failure exacerbation by direct myocardial toxicity, drug-drug interactions, or both. This scientific statement is designed to serve as a comprehensive and accessible source of drugs that may cause or exacerbate heart failure to assist healthcare providers in improving the quality of care for these patients.

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Section: Antimalarial Agentsmentioning

confidence: 99%

Section: Antimalarial Agentsmentioning

confidence: 99%

Section: Antimalarial Agentsmentioning

confidence: 99%

See 1 more Smart Citation

Drugs That May Cause or Exacerbate Heart Failure

Page¹,

O’Bryant²,

Cheng³

et al. 2016

Circulation

322

163

View full text Add to dashboard Cite

show abstract

“…Long-term chloroquine and hydroxycloroquine use is also associated with cardiomyopathy [107][108][109][110][111] often under recognized by healthcare providers [110], leading to preventable adverse events. Although cardiomyopathy phenotype can vary, the typical presentation is that of a non-genetic hypertrophic cardiomyopathy (MOGE(S) classification M H O H G N E t-CQ ) [112].…”

Section: Chloroquine and Hydroxychloroquinementioning

confidence: 99%

COVID-19 and Heart: From Clinical Features to Pharmacological Implications

Russo

Bottino

Carbone

et al. 2020

JCM

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A highly pathogenic human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been recently recognized in Wuhan, China, as the cause of the coronavirus disease 2019 (COVID-19) outbreak which has spread rapidly from China to other countries in the world, causing a pandemic with alarming morbidity and mortality. The emerging epidemiological data about COVID-19 patients suggest an association between cardiovascular diseases (CVD) and SARS-CoV-2 infection, in term of clinical features at hospital admission and prognosis for disease severity. The aim of our review is to describe the cardiological features of COVID-19 patients at admission, the acute cardiac presentation, the clinical outcome for patients with underlying CVD and the pharmacological implications for disease management.

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“…Serious life-threatening infiltrative cardiomyopathy has also been reported in very few cases; thus, to date, the host factors that contribute to cardiotoxicity remain unclear. Some authors have suggested that a high cumulative dose could be the main risk factor of such toxicity [2,3] . CASE REPORT A 41-year-old woman with systemic lupus erythematosus (SLE) was admitted to the hospital because of one month-history of shortness of breath, orthopnea and legs edema.…”

Section: Introductionmentioning

confidence: 99%

Hydroxychloroquine Myocardial Toxicity in a Patient with Systemic Lupus Erythematosus

Malchair

Labori

Rubio‐Rivas

et al. 2015

European Journal of Case Reports in Internal Medicine

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Hydroxychloroquine is an antimalarial drug used in many rheumatologic and systemic diseases. Although considered by clinicians to be relatively safe, serious side effects have been documented (retinotoxicity, neuromyotoxicity and cardiotoxicity). We present the case of a 41-year-old woman with systemic lupus erythematosus (SLE) who presented at our institution with acute heart failure after taking hydroxychloroquine for a period of 3 months. An endomyocardial biopsy ruled out myocarditis related to systemic lupus erythematosus but demonstrated pathological changes related to hydroxychloroquine toxicity. It is exceptional to observe such cardiac toxicity after such a low cumulative dose (16 grams). The potential severity and reversibility of this complication underscores the importance of a high level of suspicion and timely diagnosis. LEARNING POINTS• Since the use of hydroxychloroquine in systemic lupus erythematosus (SLE) patients is increasing, clinicians should be alert to the development of antimalarial cardiotoxicity during treatment.• In general, hydroxychloroquine myocardial toxicity should be suspected in all patients with cardiac complaints; new onset of heart failure or conduction abnormalities who received high cumulative dose; however, exceptionally, it can also be observed in SLE patients with lower doses after shorter periods of time.• The potential reversibility of cardiotoxicity after antimalarial drug suppression is possible thanks to a rapid and accurate diagnosis, which is important for assuring appropriate management of the condition.

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Cardiomyopathy Caused by Longterm Treatment with Chloroquine: A Rare Disease, or a Rare Diagnosis?

Cited by 26 publications

References 35 publications

Drugs That May Cause or Exacerbate Heart Failure

Drugs That May Cause or Exacerbate Heart Failure

COVID-19 and Heart: From Clinical Features to Pharmacological Implications

Hydroxychloroquine Myocardial Toxicity in a Patient with Systemic Lupus Erythematosus

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