ABSTRACT
Myocarditis occurs more frequently during clozapine (CLZ) administration than during treatment with other antipsychotic drugs (APs). In this observational study, we transversally screened outpatients for myocarditis by comparing a CLZ group of 132 subjects, with a non-CLZ group taking other APs (n = 371) only, and in 21 CLZ-treated patients and 18 subjects treated with other APs who had been followed for more than one year. The protocol included a) assessment of symptoms such as dyspnea, tachycardia, chest discomfort, fever, cough, and edema, b) blood pressure and heart auscultation; c) a standard electrocardiogram after a 5-minute rest, d) white cell count, and qualitative determination of troponin I, creatine-kinase-MB and myoglobin, and e) a cardiologist evaluation of subjects with suspected myocarditis. Only one case of myocarditis was detected, providing an approximation of the frequency of myocarditis of 1.6% in the first month of treatment. This was a 30-year-old man with schizophrenia who developed symptoms at day 6 after starting a treatment with 200 mg of CLZ a day without titration. Myocarditis was not observed during prolonged CLZ or other AP administration. These results support the proposal of starting CLZ treatment with a low dose and the feasibility of a simple protocol for myocarditis detection in psychiatry primary care.
El desarrollo de miocarditis ocurre con más frecuencia durante el tratamiento con clozapina (CLZ) que durante el uso de otros antipsicóticos (APs). En el presente estudio observacional evaluamos la presencia de miocarditis mediante un protocolo transversal comparando 132 sujetos tratados con CLZ con 371 pacientes tratados con otro AP, y en 21 sujetos tratados con CLZ y 18 pacientes tratados con otro AP en un protocolo longitudinal mayor 1 año de duración. La evaluación incluyó: a) detección de síntomas como disnea, taquicardia, malestar torácico, fiebre, tos y edema; b) presión arterial y auscultación cardiaca; c) electrocardiograma estándar luego de un reposo de 5 minutos; d) contaje de glóbulos blancos y determinación cualitativa de troponina I, creatin-kinasa-MB y mioglobina, y e) evaluación por un cardiólogo en sujetos sospechosos para miocarditis. Detectamos un solo caso de miocarditis, lo que permite una aproximación sobre la frecuencia de miocarditis de 1,6 % durante el primer mes de tratamiento. Se trató de un sujeto masculino con esquizofrenia que desarrolló síntomas durante el día 6 después de haber iniciado el tratamiento con CLZ a la dosis de 200 mg por día sin titulación. No se detectaron sujetos sospechosos de miocarditis durante el tratamiento prolongado con CLZ u otro AP. Estos resultados sustentan la recomendación de comenzar el tratamiento con clozapina a dosis bajas, y la factibilidad de utilizar un protocolo sencillo para detectar miocarditis en la atención psiquiátrica primaria.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Young Adult , Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Myocarditis/chemically induced , Cross-Sectional Studies , Longitudinal StudiesABSTRACT
Objetivo - Avaliar as alterações cardíacas na intoxicação exógena por paraquat. Métodos - Foi realizada análise dos dados clínicos e laboratoriais de 25 pacientes admitidos na UTI com intoxicação exógena por paraquat, de novembro de 1983 a janeiro de 1991. Resultados - A ingestão de paraquat ocorreu intencionalmente por tentativa de suicídio em 96% dos casos. A mortalidade foi de 56% com acometimento multisistêmico, nas seguintes freqüências: lesão pulmonar em 96%, lesão renal em 92%, lesão no trato gastrointestinal em 72%, alteração hepática em 56% e lesão cardíaca em 40%. Conclusão - A lesão cardíaca desencadeada pelo paraquat é freqüente (40%). A expressividade clínica das manifestações cardíacas é variável, mostrando desde alterações discretas no eletrocardiograma até necrose miocárdica aguda e maciça
Purpose - To evaluate cardiac alterations secondary to exogenous intoxication by paraquat. Methods - We performed analysis of clinical and laboratorial data of 25 patients with acute paraquat poisoning admitted in our ICU from November 1983 to January 1991. Results - There were purposeful overdoses in 24 cases (96%). The mortality rate was 56%. The lung involvement was 96%, renal was 92%, gastrointestinal tract was 72%, hepatic was 56%, and cardiac involvement was 40%. Conclusion - Cardiac involvement due to paraquat isfrequent (40%). The clinical picture of this involvement has a wide spectrum, ranging from minimal changes in the ECG to acute and extensive myocardial necrosis