Neuroleptic Cardiomyopathy: Let’s Get Acquainted

The presented mini-review summarizes the results of our own research and rather rare literature data on the problem of neuroleptic cardiomyopathy. The aspects of etiology, epidemiology, clinical course, electrocardiographic signs and pathomorphology of the disease are briefly considered. The question of nosological independence of neuroleptic cardiomyopathy is raised. Neuroleptic (antipsychotic) cardiomyopathy (NCMP) is a little known to a wide range of doctors iatrogenic pathology. It is associated with a side cardiotoxic effect of antipsychotic drugs [1-9]. The disease belongs to secondary specific metabolic dilated cardiomyopathies [10-12] and is characterized by diffusion damage of a myocardium, by sharp decrease in its contractile function and by the progressing of congestive chronic heart failure (CHF) [8,10,11,13-17].


L Mini Review
The presented mini-review summarizes the results of our own research and rather rare literature data on the problem of neuroleptic cardiomyopathy. The aspects of etiology, epidemiology, clinical course, electrocardiographic signs and pathomorphology of the disease are briefly considered. The question of nosological independence of neuroleptic cardiomyopathy is raised. Neuroleptic (antipsychotic) cardiomyopathy (NCMP) is a little known to a wide range of doctors iatrogenic pathology. It is associated with a side cardiotoxic effect of antipsychotic drugs [1][2][3][4][5][6][7][8][9]. The disease belongs to secondary specific metabolic dilated cardiomyopathies [10][11][12] and is characterized by diffusion damage of a myocardium, by sharp decrease in its contractile function and by the progressing of congestive chronic heart failure (CHF) [8,10,11,[13][14][15][16][17].
Many aspects of the epidemiology, pathogenesis, morphology, clinic and diagnosis of NCMP remain poorly studied. Therefore the purpose of this article, or should I say of mini-review, is to summarize the results of the own researches and some of the very few data of literature on this problem. Thus, although many antipsychotics, as classical, and atypical, can cause NCMP, the most common her cause is clozapine [18][19][20][21][22]. Frequency NCMP associated with taking clozapine is 0,02-0,1% [19,23].
According to E. Wooltorton [24], 80% of their patients with clozapine-induced NCMP were younger than 50 years. As a rule, the manifestation of NCMP occurs after a sufficiently long reception of antipsychotic drugs [21,25]. According to a systematic literature review conducted by M. Alawami [18], symptoms of a disease appear on average 14.4 months after initiation of clozapine treatment. As showed my researches, in its development NCMP passes three clinical stages: 1) a latent one, it is clinically fully compensated, 2) a full-scale (developed. manifesting) one, when cardiac disorders are clearly detected, but without the expressed signs of CHF and 3) a terminal one, when the clinical picture of CHF comes to the foreground [13][14][15][26][27][28]. Mortality from NCMP is 12-18% [17,24,29]. The lethal outcome in latent and in developed stages either comes from the intercurrent diseases or is the sudden cardiac death of arhythmogenic genesis [10,26,28]. The last is observed at 44.2 % of the dead of NCMP according to my data [31,30]. In a terminal stage the progressing CHF serves as an immediate cause of death [10,26,28].
The clinical course of NCMP is similar to that of idiopathic dilated cardiomyopathy [10]. The disease develops slowly and at the beginning is hardly noticeable. In a latent stage it is practically Deviation of an electric axis of a heart to the left; d) Overload of the right departments of the heart; e) Hypertrophy of the left ventricle [10,11,14,15,17,33].
In the developed stage the clinic of NCMP is rather distinctly shown, but the signs of terminal CHF are absent or poorly noticeable.
The complaints of patients are more certain: weakness, fatigue, heartbeating, short wind at moderate physical activity, sometimes passing pains in the cardiac region. By the physical examination the deafness of cardiac sounds, some expansion of the borders of a heart, tachycardia, passing breathlessness notes. During this period the steadily normal or labile arterial pressure equally often meets, but there is a tendency to the moderate increase of it [10,26]. The