Hydroxychloroquine and risk of cardiac decompensation

Lindsey Tilling

doi:10.31579/2690-4861/053

Abstract

Background Hydroxychloroquine (HCQ) is a 4-aminoquinoline derivative, used in the treatment of malaria and rheumatic diseases. HCQ has also been suggested as a treatment in patients suffering from severe acute respiratory syndrome–coronavirus 2 (SARS–CoV-2). One of the cardiac complications of SARS-CoV-2 is myocarditis and ventricular dysfunction. Case summary We present the case of a 52 year old lady presenting with 2 months history of breathlessness, found to have severely impaired left ventricular function. She had been taking HCQ for 28 months for seronegative inflammatory arthritis. No cause was identified on initial investigation. She was treated with optimal medical therapy, and HCQ was stopped. After 5 months a cardiac MRI scan revealed full remodelling of the ventricle. Discussion This case highlights one of the lesser recognized side effects of HCQ, and the potential for severe cardiac dysfunction. As this drug continues to be investigated and used in the management of SARS-CoV-2 it is important to recognize the potential for cardiac decompensation in patients who are already at increased risk of myocardial dysfunction.

Highlights

Hydroxychloroquine (HCQ) is a 4-aminoquinoline derivative, used in the treatment of malaria and rheumatic diseases
Case summary: We present the case of a 52 year old lady presenting with 2 months history of breathlessness, found to have severely impaired left ventricular function
After 5 months a cardiac MRI scan revealed full remodelling of the ventricle. This case highlights one of the lesser recognized side effects of HCQ, and the potential for severe cardiac dysfunction. As this drug continues to be investigated and used in the management of SARS-CoV-2 it is important to recognize the potential for cardiac decompensation in patients who are already at increased risk of myocardial dysfunction

Summary

Discussion

This patient presented in decompensated, newly diagnosed heart failure with severely reduced ejection fraction. SARS-CoV-2 itself may predispose to cardiac decompensation; the incidence of heart failure has been recorded as between 23 – 33% in severely- critically ill hospitalized patients [8, 9]. There has been some suggestion of prophylactic use of HCQ against SARS-CoV-19 infection; if this translates into clinical practice, there will have to be robust processes for assessing cardiovascular risk in HCQ recipients. This case highlights one of the lesser recognized side effects of HCQ, and the potential for severe cardiac dysfunction. As this drug continues to garner interest as a potential weapon in the battle against SARS-CoV-19, it is important to recognize the potential for cardiac decompensation in patients who are already at increased risk of myocardial dysfunction

Introduction