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Table of Contents
Vol. 107, No. 2, 2007
Issue release date: February 2007
Section title: Case Report
Cardiology 2007;107:73–80
(DOI:10.1159/000094079)

Cardiomyopathy Related to Antimalarial Therapy with Illustrative Case Report

Costedoat-Chalumeau N.a · Hulot J.-S.b · Amoura Z.a · Delcourt A.c · Maisonobe T.d · Dorent R.e · Bonnet N.f · Sablé R.a · Lechat P.b · Wechsler B.a · Piette J.-C.a
aService de Médecine Interne, bService de Pharmacologie, cLaboratoire d’anatomopathologie, dExploration fonctionnelles neurologiques, eDépartement de Cardiologie, and fService de Chirurgie Thoracique et Cardio-vasculaire, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France

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Article / Publication Details

First-Page Preview
Abstract of Case Report

Received: February 02, 2006
Accepted: April 25, 2006
Published online: June 22, 2006
Issue release date: February 2007

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 1

ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)

For additional information: http://www.karger.com/CRD

Abstract

The antimalarial agents, chloroquine (CQ) and hydroxychloroquine (HCQ) are used in long-term treatment of connective tissue diseases and dermatological disorders and are generally regarded as safe. We present one case of cardiotoxicity in a 59-year-old woman treated with antimalarials during 13 years for a discoid lupus erythematosus. She progressively developed conduction disturbances and congestive heart failure (CHF). When the diagnosis of antimalarials toxicity was suspected, CQ was withdrawn. However, heart transplantation had to be performed in the following 4 months for severe CHF. Indeed, rare but severe cardiotoxicity may develop following prolonged use of antimalarials with both conduction disturbances (45 patients) and CHF (25 patients). These cardiac toxic effects have been reported with CQ and less frequently with HCQ use alone. Diagnoses are often delayed since the toxicity of the drug might be misattributed to other factors in these patients. The endomyocardial biopsy, or in some cases the muscle biopsy, are essential to confirm the antimalarials toxicity. Antimalarials have been stopped in 12 cases of CHF, leading to improvement in 8 cases (within 3 months to 5 years) and to deaths or to heart transplantation in 4 cases (within 1 week to 3 months). In the latter cases, as in our patient, the lack of improvement may have been explained by the severity of the cardiomyopathy at diagnosis and the short delay since withdrawal. As a consequence, the potential for reversibility and the severity in undiagnosed cases of these toxic cardiomyopathies emphasize the importance of recognizing early signs of toxicity in order to withdraw antimalarials before the occurrence of life-threatening CHF.

© 2007 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Case Report

Received: February 02, 2006
Accepted: April 25, 2006
Published online: June 22, 2006
Issue release date: February 2007

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 1

ISSN: 0008-6312 (Print)
eISSN: 1421-9751 (Online)

For additional information: http://www.karger.com/CRD


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.