Clozapine-induced pericarditis.

OBJECTIVE: To report a case of a patient treated with clozapine who developed pericarditis with pericardial effusion that resolved when the drug was discontinued. METHOD: Case report of a 21-year-old man with psychotic disorder that had been stable on clozapine therapy for five months (after failure of atypical antipsyhotic agents) presented to the emergency department complaining of chest pain and progressive shortness of breath that had lasted for a few days. Echocardiography showed a pericardial effusion suggestive of a cardiac tamponade, and the fluid was removed by pericardiocentesis. All other possible causes of the pericardial effusion were ruled out and clozapine was suspected as the most likely explanation. Clozapine was discontinued and the patient's symptoms improved markedly. DISCUSSION: According to the Naranjo probability scale, clozapine is a probable cause of pericarditis. Although clozapine is a known cause of myocarditis and cardiomyopathy, there are only several reports in the literature describing clozapine-induced pericarditis and pericardial effusion. In our patient, the pericardial effusion cleared within several days following clozapine discontinuation. CONCLUSION: There have been only a few cases of clozapine-induced pericarditis reported in the literature, however this adverse effect of clozapine can occur, as this case report clearly demonstrates. Cardiac adverse effects of clozapine are potentially life threatening, hence early recognition is essential to prevent serious outcomes.

[Hypertension as a risk factor in acute infarct in young people]. / Hipertenzija kao rizik u akutnom infarktu mladih.

INTRODUCTION: Hypertension is one of the most frequent risk factors for acute myocardial infarction. The aim of this paper was to establish both the incidence of hypertension as a risk factor for myocardial infarction in young people and its characteristics. METHODS: The investigation involved patients younger than 40 years of age with acute myocardial infarction treated at the Institute of Cardiovascular Diseases in Sremska Kamenica from 1989 to 1994. RESULTS: The investigation involved 80 patients with acute myocardial infarction younger than 40 years--40 male and 40 female. Hypertension as a risk factor was found in 22 (55%) women and in 14 (35%) men and it was a moderate hypertension of systolic-diastolic type or unstable hypertension. In 10 (27.77%) investigated patients hypertension was detected during hospitalization (before that, it had not been controlled) while in 22 (61%) it was not seriously taken into account either by the patients, or their physicians and therefore it was not treated. As a single risk factor hypertension was found in 4 (10%) women, while it was not found in men. DISCUSSION: Hypertension is found in 10-15% of population, and in 10% young men and women. The existence of hypertension as the only risk factor for the occurrence of acute myocardial infarction was sufficient in these women, although it was considered that women in their generative period are protected from ishaemic heart diseases by their hormonal status. All that points to hypertension as a secret and mysterious killer. CONCLUSION: Hypertension as a risk factor was found in 22 (55%) women, and in 14 (35%) men. In 10% of women hypertension was the only risk factor, while it was not found as such in men. It was quite sufficient in these women for the occurrence of acute myocardial infarction, although it was considered that women in their generative period are protected from ishaemia in heart diseases by their hormonal status. Detection and adequate treatment of hypertension are of great importance as well as elimination of other risk factors.

[Coronary score in patients with low ejection fraction after myocardial infarct]. / Koronarni skor u bolesnika sa niskom ejekcionom frakcijom nakon prelezanog infarkta miokarda.

INTRODUCTION: The most frequent cause of heart failure is ischemic heart disease (1). This paper was aimed at comparing the coronary score of patients with low ejection fraction whose ejection fraction was not significantly changed after sustained myocardial infarction. MATERIAL AND METHODS: The study involved patients after sustained myocardial infarction treated at the Institute of Cardiovascular Diseases in Sremska Kamenica. Total coronary score and score of each individual coronary artery were emphasized. RESULTS: The investigation study comprised 56 patients aged 33-83 years of various occupations. Patients were divided into two groups: the first--A group consisted of 28 (50%) patients with ejection fraction 35% or lower; the second--B group also consisted of 28 (50%) patients with ejection fraction higher that 35%. Table 1. shows the dominant coronary artery in investigated groups of patients. Table 2. shows values of total and scores of each coronary artery. The right coronary artery was dominant in 75% of patients from the A group and in 82.1% of patients from the B group. A significantly higher individual score of coronary arteries, as well as the total score, was established in the group of patients with low ejection fraction, and especially the score of the anterior descendent artery which is almost twice higher in regard to the second group of examined patients. Table 3. describes the analyzed score in male and female patients. DISCUSSION: Patients with low ejection fraction after sustained myocardial infarction have more changes of coronary arteries than patients with better ejection fraction. The total score, score of the right coronary artery (ACD), circumflex artery (RCX) and especially anterior descendent artery (LAD) are significantly higher in patients with ejection fraction lower than 35%. There are no differences in the dominant coronary artery in investigated patients. In both investigated groups women had a smaller score of ACD and RCX and a higher score of LAD, but the difference is not significant. In regard to total score there were no differences in men and women. Numerous investigations also point to the fact that patients with lower ejection fraction and ischemic heart disease have more changes on coronary artery than patients with better ejection fraction. CONCLUSION: 1. Patients with low ejection fraction after sustained myocardial infarction have a higher total score and scores of ACD. LAD and RCX. 2. There are no differences in coronary score of men and women within the same investigated groups. 3. There are no differences in dominant coronary artery in investigated groups of patients.

[Ischemic heart disease in young women. Its importance and possibilities of prevention]. / Ishemijska bolest srca u mladih zena. Vaznost i mogucnost prevencije.

Ischemic heart disease in young women is a rare disease, but nowadays it is more frequently detected. The investigation involved 83 women up to the age of 19 with ischemic heart disease. The most frequent risk factors were as follows: hypertension, hyperlipoproteinaemia, smoking, stress and obesity. The association of three factors was most often observed. Electrocardiogram at rest pointed to the changes as follows: anteroseptal region, the whole anterior wall, postero-inferior region and subendocardial localization. Out of 11 exercise tests 36 (81.81%) of them were positive. Coronary arteriography was performed in 72 (86.71%), with positive changes in 61 (81.72%) patients. Occlusive changes were most frequently found on anterior descendent artery. Since a great number of risk factors in women may be easily corrected by an adequate diet and healthier way of life, their detection and implementation of measures of primary and secondary prevention have been attached a great importance.