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A Case of Amitriptyline-induced Myocarditis

Amitriptyline is a widely prescribed tricyclic antidepressant (TCA) with a very concerning cardiotoxicity profile, but it is one that has not been discussed much in literature. Here, we present a case of amitriptyline toxicity presenting as myocarditis with pericardial involvement. A 21-year-old mal...

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Autores principales: Kassim, Thamer, Mahfood Haddad, Toufik, Rakhra, Amandeep, Kabach, Amjad, Qurie, Ahmad, Selim, Mohammad, Nayfeh, Ali S, Aly, Ahmed, Holmberg, Mark J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233954/
https://www.ncbi.nlm.nih.gov/pubmed/30430045
http://dx.doi.org/10.7759/cureus.2840
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author Kassim, Thamer
Mahfood Haddad, Toufik
Rakhra, Amandeep
Kabach, Amjad
Qurie, Ahmad
Selim, Mohammad
Nayfeh, Ali S
Aly, Ahmed
Holmberg, Mark J
author_facet Kassim, Thamer
Mahfood Haddad, Toufik
Rakhra, Amandeep
Kabach, Amjad
Qurie, Ahmad
Selim, Mohammad
Nayfeh, Ali S
Aly, Ahmed
Holmberg, Mark J
author_sort Kassim, Thamer
collection PubMed
description Amitriptyline is a widely prescribed tricyclic antidepressant (TCA) with a very concerning cardiotoxicity profile, but it is one that has not been discussed much in literature. Here, we present a case of amitriptyline toxicity presenting as myocarditis with pericardial involvement. A 21-year-old male with no previous cardiac history presented to the emergency department (ED) with a decreased level of consciousness after an amitriptyline overdose as a suicidal attempt. For concerns with airway protection, the patient was intubated and subsequently admitted to the intensive care unit (ICU). An electrocardiogram (EKG) showed sinus tachycardia, prolonged QRS complex, prolonged QTc interval, and nonspecific ST-T wave changes. Intravenous fluid resuscitation and sodium bicarbonate were administered with a target blood pH of 7.5 to 7.55. Two days later, the patient was taken off mechanical ventilation and improved clinically. However, troponin levels began to rise with a peak level of 4.08 µg/L. He then began having fevers, elevated white blood cell counts (WBCs), and elevated inflammatory markers. Transthoracic echo (TTE) revealed an ejection fraction (EF) of 45%-50%, no wall segment motion abnormalities, and a mild-to-moderate pericardial effusion. Cardiac magnetic resonance (CMR) was done, which revealed changes indicative of acute myocarditis, moderate pericardial effusion, a calculated EF of 45% with a moderate left ventricular dilation, and no coronary artery stenosis or anomalous coronary artery origin. Given the patient’s age, the absence of cardiac risk factors, and the presence of an amitriptyline overdose along with his EKG, TTE, and CMR findings, we hypothesize that this myocarditis with pericardial involvement is due to amitriptyline-induced direct toxicity.
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spelling pubmed-62339542018-11-14 A Case of Amitriptyline-induced Myocarditis Kassim, Thamer Mahfood Haddad, Toufik Rakhra, Amandeep Kabach, Amjad Qurie, Ahmad Selim, Mohammad Nayfeh, Ali S Aly, Ahmed Holmberg, Mark J Cureus Cardiology Amitriptyline is a widely prescribed tricyclic antidepressant (TCA) with a very concerning cardiotoxicity profile, but it is one that has not been discussed much in literature. Here, we present a case of amitriptyline toxicity presenting as myocarditis with pericardial involvement. A 21-year-old male with no previous cardiac history presented to the emergency department (ED) with a decreased level of consciousness after an amitriptyline overdose as a suicidal attempt. For concerns with airway protection, the patient was intubated and subsequently admitted to the intensive care unit (ICU). An electrocardiogram (EKG) showed sinus tachycardia, prolonged QRS complex, prolonged QTc interval, and nonspecific ST-T wave changes. Intravenous fluid resuscitation and sodium bicarbonate were administered with a target blood pH of 7.5 to 7.55. Two days later, the patient was taken off mechanical ventilation and improved clinically. However, troponin levels began to rise with a peak level of 4.08 µg/L. He then began having fevers, elevated white blood cell counts (WBCs), and elevated inflammatory markers. Transthoracic echo (TTE) revealed an ejection fraction (EF) of 45%-50%, no wall segment motion abnormalities, and a mild-to-moderate pericardial effusion. Cardiac magnetic resonance (CMR) was done, which revealed changes indicative of acute myocarditis, moderate pericardial effusion, a calculated EF of 45% with a moderate left ventricular dilation, and no coronary artery stenosis or anomalous coronary artery origin. Given the patient’s age, the absence of cardiac risk factors, and the presence of an amitriptyline overdose along with his EKG, TTE, and CMR findings, we hypothesize that this myocarditis with pericardial involvement is due to amitriptyline-induced direct toxicity. Cureus 2018-06-19 /pmc/articles/PMC6233954/ /pubmed/30430045 http://dx.doi.org/10.7759/cureus.2840 Text en Copyright © 2018, Kassim et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Kassim, Thamer
Mahfood Haddad, Toufik
Rakhra, Amandeep
Kabach, Amjad
Qurie, Ahmad
Selim, Mohammad
Nayfeh, Ali S
Aly, Ahmed
Holmberg, Mark J
A Case of Amitriptyline-induced Myocarditis
title A Case of Amitriptyline-induced Myocarditis
title_full A Case of Amitriptyline-induced Myocarditis
title_fullStr A Case of Amitriptyline-induced Myocarditis
title_full_unstemmed A Case of Amitriptyline-induced Myocarditis
title_short A Case of Amitriptyline-induced Myocarditis
title_sort case of amitriptyline-induced myocarditis
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233954/
https://www.ncbi.nlm.nih.gov/pubmed/30430045
http://dx.doi.org/10.7759/cureus.2840
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