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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
Summary
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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