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Related Experiment Videos

Methotrexate-linked ventricular arrhythmias

R Kettunen1, H V Huikuri, A Oikarinen

  • 1Department of Internal Medicine, Oulu University Central Hospital, Finland.

Acta Dermato-Venereologica
|September 1, 1995
PubMed
Summary

Methotrexate, a medication for psoriasis, can cause serious heart rhythm problems like ventricular ectopy. Discontinuation of methotrexate effectively resolved these cardiac arrhythmias in a patient with a history of myocardial infarction.

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Area of Science:

  • Cardiology
  • Pharmacology
  • Dermatology

Background:

  • A 36-year-old male with a history of myocardial infarction and cardiac arrest was treated for psoriasis.
  • The patient received weekly oral doses of methotrexate, up to 10 mg.

Observation:

  • Hospitalization occurred due to anginal pain and palpitation.
  • Electrocardiogram monitoring revealed significant ventricular ectopy, with up to 580 premature beats per hour.

Findings:

  • Ventricular premature beats significantly decreased upon methotrexate discontinuation.
  • Cardiac arrhythmias recurred shortly after re-initiation of methotrexate therapy.
  • Coronary angiography showed minimal abnormalities; electrophysiological testing and biopsy were normal.

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Implications:

  • Methotrexate may induce or exacerbate ventricular arrhythmias in susceptible individuals.
  • This case highlights the importance of considering drug-induced cardiotoxicity in patients with pre-existing cardiac conditions.
  • Careful cardiac monitoring is warranted in patients treated with methotrexate, especially those with cardiovascular risk factors.