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Assessment: Nursing management of patients with cardiomyopathy begins with a thorough assessment of the patient's history, including a family history of cardiomyopathy or sudden cardiac death, personal history of heart disease, hypertension, diabetes, and any alcohol consumption or drug use.During the physical examination, assess vital signs, look for signs of heart failure (such as edema, jugular venous distention, and cyanosis), auscultate for abnormal heart sounds (like murmurs and gallops),...
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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
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Progressive Conduction System Disease in Hydroxychloroquine Cardiotoxicity: A Call for Early Vigilance.

Milica Vukićević1, Mandeep R Mehra2, Robert F Padera3

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Hydroxychloroquine (HCQ) can cause deadly heart conduction problems. This case shows HCQ toxicity damages heart nodes, leading to irreversible injury and sudden death, even with pacing.

Keywords:
cardio-toxicityconduction system diseasehydroxychloroquinelysosomal destruction

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Area of Science:

  • Cardiology
  • Toxicology
  • Pathology

Background:

  • Hydroxychloroquine (HCQ) cardiotoxicity is a growing concern.
  • Progressive conduction system disease is an underrecognized, potentially lethal HCQ side effect.

Purpose of the Study:

  • To report a case of fatal HCQ-induced cardiotoxicity.
  • To highlight the lysosomal mechanism of HCQ toxicity in cardiac conduction.

Main Methods:

  • Case report of a 67-year-old female on chronic HCQ.
  • Clinical presentation, management with atrial pacing, and autopsy findings.

Main Results:

  • Patient developed progressive conduction abnormalities, cardiogenic shock, and sudden death.
  • Autopsy revealed sinoatrial and atrioventricular nodal lysosomal toxicity and fibrosis.

Conclusions:

  • HCQ cardiotoxicity can manifest as primary, irreversible conduction system disease.
  • Lysosomal damage underlies HCQ's lethal cardiac effects.
  • ECG monitoring and early dual-chamber pacing may prevent adverse outcomes.