Quetiapine-induced myocarditis presenting as acute STEMI

Area of Science:

• Cardiology
• Psychiatry
• Pharmacology

Background:

• Attention-deficit hyperactivity disorder (ADHD) is commonly treated with stimulant medications.
• Quetiapine is an atypical antipsychotic used for various psychiatric conditions.

Observation:

• An 18-year-old male with ADHD on methylphenidate was initiated on quetiapine.
• He presented with chest pain, ST elevation, elevated troponin, and echocardiogram findings of mild left ventricular dysfunction.

Findings:

• Coronary angiography revealed normal coronary arteries.
• Cardiac MRI indicated subepicardial late gadolinium enhancement, consistent with myocarditis.
• Symptoms resolved, and cardiac function normalized after discontinuing quetiapine and methylphenidate.

Implications:

• This case highlights a potential association between quetiapine use and drug-induced myocarditis in adolescents.
• Careful monitoring for cardiac adverse effects is crucial when initiating or combining psychotropic medications.
• Further research is warranted to elucidate the specific mechanisms and prevalence of this adverse reaction.