[Drug-induced valve heart disease]

Drug-induced valve heart disease. Numerous reports have shown an unquestionable association between fibrotic valve heart disease (VHD) and the following drugs: ergot alkaloids (methysergide and ergotamine), ergot-derived dopaminergic agonists (pergolide and cabergoline) and drugs metabolized into norfenfluramine (fenfluramine, dexfenfluramine and benfluorex). These drugs have a common pharmacological action on a specific serotonin receptor - the 5HT2B receptor leading to VHD. All four valves can be affected, but the mitral and aortic valves are predominantly involved. Echocardiography is the method of choice to detect these VHD and evaluate its severity. The most characteristic feature is restriction of valve motion, mainly responsible for regurgitation. Histological examination is typical, but rarely available. Drug-induced VHD may be severe, requiring cardiac surgery. The subsequent course is not well documented, varies from one patient to another, with the possibility of regression, stabilisation or deterioration.