Abstract
To our knowledge, there have been no case reports associating amisulpride treatment with myocarditis or cardiomyopathy. We present a case of cardiomyopathy which followed the initiation of amisulpride therapy.
Mr W is a 29-year-old married father of two children who is unemployed and a case-managed patient of our service with a history of schizophrenia, alcohol abuse and panic disorder. He was on treatment with olanzapine for over a year and was stable. After his blood sugar level was found to be elevated, it was suggested that he be weaned off olanzapine and commenced on amisulpride, which he had never taken before.
Amisulpride was initiated 1 week prior to hospitalization. During that time he became increasingly short of breath with chest pains, palpitations and fevers. On admission to hospital he had gross pulmonary oedema and required intubation and admission to the intensive care unit.
Cardiac ultrasound showed a very dilated left ventricle of 78mm (normal <56 mm) with severely depressed systolic function (estimated ejection fraction of <20%) and mild mitral regurgitation.
His other initial investigations included left lower lobe pneumonia on CXR and neutrophilia. His creatinine kinase peaked at 343 on day 2 of his admission and white blood cell count peaked at 23.3 on day 3. He may have been exposed to a local outbreak of enteroviral infection but he had had no gastrointestinal symptoms and his viral serology was negative. A myocardial biopsy was not performed.
He had a prolonged admission to the intensive care unit and his treatment included inotropic agents and antibiotics. He had a tracheotomy performed. He was finally discharged from hospital 6 weeks after admission. His cardiac drugs at discharge included an ACE inhibitor (perindopril) and a beta-blocker (carvedilol). He was not on any antipsychotic drugs. His cardiac function on ultrasound at discharge showed no improvement.
The cause of this man's cardiomyopathy is uncertain. Often this condition is attributed to post-viral infection with cardiac symptoms appearing about 2 weeks after a viral illness [1], but there was no clear flu-like episode in this man's case. Drugs such as clozapine, olanzapine and quetiapine have been linked with myocarditis [1–3]. There have also been reports of an association between panic disorder and cardiomyopathy [4], [5].
Although we cannot definitely attribute this man's cardiomyopathy to the initiation of amisulpride therapy, we would be interested to know if other similar presentations have been observed.