Cardiac Valvular Disease in Asymptomatic Patients Who Have Had Antiobesity Medication

Abstract

Introduction:

Antiobesity medications have been known to cause pulmonary hypertension and cardiac valvular disease. There is a risk in patients who have taken these medications of sudden hypotension when general anesthesia is induced. This article is a review of the current literature on the subject of valvular disease in asymptomatic patients who have taken antiobesity medications.

Materials and Methods:

The results of five independent surveys of patients who had been exposed to fenfluramine or dexfenfluramine but who had no obvious history of cardiac disease or cardiac symptoms were reviewed.

Results:

As detected by echocardiogram evaluation, the presence of significant valvular disease ranged from 30.0% to 38.3%. For patients having less than 3 months or 3 to 5 months of exposure to the drugs, 22% showed evidence of valvular disease. For patients exposed to the drugs for 6 or more months, the percentage showing valvular disease increased to 35%. An audible cardiac murmur was present in 17% of patients.

Discussion:

The American College of Cardiology issued recommendations that patients who have a history of fenfluramine or dexfenfluramine use undergo a careful cardiovascular physical examination, which should be followed by an echocardiogram in patients with cardiac murmurs or symptoms. The US Department of Health and Human Services Guidelines state that an echocardiogram should be performed on all patients who have taken these drugs.