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Chloroquine cardiomyopathy: beyond ocular adverse effects

Nilson Lopez-Ruiz1, Carlos Esteban Uribe2

  • 1Division of Cardiology, Hospital Pablo Tobon Uribe, Medellin, Antioquia, Colombia.

BMJ Case Reports
|September 17, 2014
PubMed

Insights

Long-term chloroquine use for systemic lupus erythematosus can cause severe heart problems, including atrioventricular block. Early detection and drug withdrawal may improve cardiac function.

Area of Science:

  • Cardiology
  • Rheumatology
  • Toxicology

Background:

  • Systemic lupus erythematosus (SLE) is an autoimmune disease often treated with antimalarial drugs like chloroquine.
  • Long-term chloroquine therapy is associated with various toxicities, but cardiac involvement requires careful monitoring.

Observation:

  • A 36-year-old woman on long-term chloroquine for SLE developed third-degree atrioventricular block requiring a pacemaker.
  • Echocardiography and cardiac MRI revealed left ventricular thickening and mild systolic dysfunction without a clear cause.

Findings:

  • Endomyocardial biopsy showed vacuolar degeneration of myocytes and curvilinear bodies, diagnostic of chloroquine cardiotoxicity.
  • Withholding chloroquine and initiating candesartan and carvedilol led to clinical improvement and improved left ventricular systolic function at 2-year follow-up.

Implications:

  • Chloroquine cardiotoxicity is a potentially life-threatening complication of SLE treatment.
  • Physicians must be vigilant for cardiac effects in patients on long-term chloroquine therapy.
  • Prompt diagnosis and management, including drug cessation, can reverse cardiac dysfunction.

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