C-reactive protein: an early critical sign of clozapine-related myocarditis
Sasha R Fehily1, Rosaria Forlano2, Paul B Fitzgerald3
1Resident Medical Officer, Department of Psychiatry, Alfred Health, Melbourne, VIC, Australia S.Fehily@alfred.org.au.
Objective:
We present a case of clozapine-related myocarditis, with a rising C-reactive protein as the only initial evidence supporting the diagnosis.
Method:
An otherwise healthy young male presenting with treatment-resistant schizophrenia was started on clozapine. Monitoring was performed.
Results:
At day 18 he developed fever, tachycardia and a raised C-reactive protein, while troponin levels and echocardiogram remained normal.
Conclusions:
Current protocols monitoring for myocarditis have their limitations and can often only be used to support a presumptive diagnosis of myocarditis. In keeping with the current clozapine monitoring guidelines, we demonstrate that a rise in C-reactive protein levels can be a critical early sign of myocarditis warranting close monitoring and serious consideration for cessation of clozapine.
Related Concept Videos
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:14Myocarditis III: Medical Management
01:21Myocarditis I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...