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Dilated cardiomyopathy: an unusual complication of clozapine therapy
Badira Makhoul1, Irit Hochberg, Shmuel Rispler
1Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.
Background:
A 42-year-old obese man presented with acute pulmonary edema. He had a history of chronic residual schizophrenia for which he had been taking clozapine for 7 years, but had no known prior cardiac disease. Echocardiography demonstrated severe biventricular systolic and diastolic dysfunction with severe left ventricular enlargement. Cardiac catheterization showed no coronary artery disease.
Investigations:
Physical examination, chest radiography, electrocardiography, transthoracic echocardiography, laboratory testing, viral serology, cardiac catheterization, coronary angiography and abdominal and renal ultrasonography.
Diagnosis:
Clozapine-induced dilated cardiomyopathy.
Management:
Intravenous nesiritide, furosemide and morphine followed by oral heart-failure therapy comprising ramipril, metoprolol succinate, spironolactone, and furosemide. Clozapine therapy was withdrawn.
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