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Chloroquine-induced cardiomyopathy-echocardiographic features
Tasneem Z Naqvi1, Daniel Luthringer, Alberto Marchevsky
1Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. tasneem.naqvi@cshs.org
Summary
Long-term chloroquine use in systemic lupus erythematosus can cause reversible cardiomyopathy affecting heart valves and the conduction system. Discontinuation led to significant clinical improvement and echocardiographic reversal.
Area of Science:
- Cardiology
- Rheumatology
- Pharmacology
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease often treated with antimalarial drugs like chloroquine sulfate.
- Chloroquine use has been associated with various toxicities, but cardiac involvement is less commonly reported.
Observation:
- A 61-year-old woman with a 30-year history of SLE on chloroquine presented with complete heart block, congestive heart failure, and restrictive cardiomyopathy.
- Cardiac imaging revealed valve thickening and regurgitation, while MRI showed increased gadolinium uptake in the interventricular septum and left ventricular lateral wall.
- Endomyocardial biopsy demonstrated myocardial vacuolation and myelin figures.
Findings:
- The patient experienced significant clinical improvement and reversal of cardiomyopathy on echocardiography seven months after discontinuing chloroquine.
- This case highlights a chloroquine-induced cardiomyopathy involving the conduction system, cardiac valves, and myocardium.
Implications:
- This report is the first to describe a reversible cardiomyopathy linked to prolonged chloroquine use, emphasizing the need for cardiac monitoring in patients on long-term therapy.
- Discontinuation of chloroquine may lead to recovery of cardiac function, suggesting a drug-induced etiology.