Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review

Pramod Theetha Kariyanna; Andrew Doodnauth; Mrinali Shetty; Benjamin Ramalanjaona; Naseem Hossain; Yuvraj Singh Chowdhury; Nimrah Hossain; Apoorva Jayarangaiah; Adam Budzikowski

doi:doi:10.11648/j.ijcems.20210701.15

Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review

Pramod Theetha Kariyanna, Andrew Doodnauth, Mrinali Shetty, Benjamin Ramalanjaona, Naseem Hossain, Yuvraj Singh Chowdhury, Nimrah Hossain, Apoorva Jayarangaiah, Adam Budzikowski

Published in International Journal of Clinical and Experimental Medical Sciences (Volume 7, Issue 1)

Received: 14 May 2020 Accepted: 9 September 2020 Published: 9 February 2021

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Abstract

Hydroxychloroquine and Chloroquine are commonly used for the treatment of malaria and autoimmune conditions. Most recently, hydroxychloroquine has been implicated in the treatment armamentarium of Severe acute respiratory syndrome (SARS) caused by SARS-associated coronavirus-2. A rare, underreported side effect of hydroxychloroquine and chloroquine is cardiotoxicity. The cardiomyopathy occurs as a result of inhibition of lysosomal enzymes causing lysosomal dysfunction and intra-cellular accumulation of metabolic byproducts in the myocardium, leading to hypertrophy with or without restrictive physiology and resultant conduction abnormalities. Based on our review of 57 reported cases of hydroxychloroquine or chloroquine induced cardiomyopathy, dyspnea was the most common associated symptom. The most common rhythms seen on EKG were as follows: complete heart block (18.75%), right bundle branch block (RBBB) (18.75%). The most common findings on echocardiography were left ventricular hypertrophy (LVH) (54%), systolic dysfunction (48%) and diastolic dysfunction (32%). A definitive diagnosis is established by endomyocardial biopsy which demonstrates the presence of curvilinear inclusion bodies. The outcome following cessation of the offending agent ranges from complete reversal in 45% of the cases to continued progression with need for cardiac transplantation or even death in 17.5% of the cases.

Published in	International Journal of Clinical and Experimental Medical Sciences (Volume 7, Issue 1)
DOI	10.11648/j.ijcems.20210701.15
Page(s)	31-36
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Drug-induced Cardiomyopathy, Hydroxychloroquine, Chloroquine, Biventricular Hypertrophy, Non-ischemic Cardiomyopathy, Complete Heart Block, Inclusion Bodies

References

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APA Style

Pramod Theetha Kariyanna, Andrew Doodnauth, Mrinali Shetty, Benjamin Ramalanjaona, Naseem Hossain, et al. (2021). Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. International Journal of Clinical and Experimental Medical Sciences, 7(1), 31-36. https://doi.org/10.11648/j.ijcems.20210701.15

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ACS Style

Pramod Theetha Kariyanna; Andrew Doodnauth; Mrinali Shetty; Benjamin Ramalanjaona; Naseem Hossain, et al. Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. Int. J. Clin. Exp. Med. Sci. 2021, 7(1), 31-36. doi: 10.11648/j.ijcems.20210701.15

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AMA Style

Pramod Theetha Kariyanna, Andrew Doodnauth, Mrinali Shetty, Benjamin Ramalanjaona, Naseem Hossain, et al. Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. Int J Clin Exp Med Sci. 2021;7(1):31-36. doi: 10.11648/j.ijcems.20210701.15

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@article{10.11648/j.ijcems.20210701.15,
  author = {Pramod Theetha Kariyanna and Andrew Doodnauth and Mrinali Shetty and Benjamin Ramalanjaona and Naseem Hossain and Yuvraj Singh Chowdhury and Nimrah Hossain and Apoorva Jayarangaiah and Adam Budzikowski},
  title = {Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {7},
  number = {1},
  pages = {31-36},
  doi = {10.11648/j.ijcems.20210701.15},
  url = {https://doi.org/10.11648/j.ijcems.20210701.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20210701.15},
  abstract = {Hydroxychloroquine and Chloroquine are commonly used for the treatment of malaria and autoimmune conditions. Most recently, hydroxychloroquine has been implicated in the treatment armamentarium of Severe acute respiratory syndrome (SARS) caused by SARS-associated coronavirus-2. A rare, underreported side effect of hydroxychloroquine and chloroquine is cardiotoxicity. The cardiomyopathy occurs as a result of inhibition of lysosomal enzymes causing lysosomal dysfunction and intra-cellular accumulation of metabolic byproducts in the myocardium, leading to hypertrophy with or without restrictive physiology and resultant conduction abnormalities. Based on our review of 57 reported cases of hydroxychloroquine or chloroquine induced cardiomyopathy, dyspnea was the most common associated symptom. The most common rhythms seen on EKG were as follows: complete heart block (18.75%), right bundle branch block (RBBB) (18.75%). The most common findings on echocardiography were left ventricular hypertrophy (LVH) (54%), systolic dysfunction (48%) and diastolic dysfunction (32%). A definitive diagnosis is established by endomyocardial biopsy which demonstrates the presence of curvilinear inclusion bodies. The outcome following cessation of the offending agent ranges from complete reversal in 45% of the cases to continued progression with need for cardiac transplantation or even death in 17.5% of the cases.},
 year = {2021}
}

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TY  - JOUR
T1  - Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review
AU  - Pramod Theetha Kariyanna
AU  - Andrew Doodnauth
AU  - Mrinali Shetty
AU  - Benjamin Ramalanjaona
AU  - Naseem Hossain
AU  - Yuvraj Singh Chowdhury
AU  - Nimrah Hossain
AU  - Apoorva Jayarangaiah
AU  - Adam Budzikowski
Y1  - 2021/02/09
PY  - 2021
N1  - https://doi.org/10.11648/j.ijcems.20210701.15
DO  - 10.11648/j.ijcems.20210701.15
T2  - International Journal of Clinical and Experimental Medical Sciences
JF  - International Journal of Clinical and Experimental Medical Sciences
JO  - International Journal of Clinical and Experimental Medical Sciences
SP  - 31
EP  - 36
PB  - Science Publishing Group
SN  - 2469-8032
UR  - https://doi.org/10.11648/j.ijcems.20210701.15
AB  - Hydroxychloroquine and Chloroquine are commonly used for the treatment of malaria and autoimmune conditions. Most recently, hydroxychloroquine has been implicated in the treatment armamentarium of Severe acute respiratory syndrome (SARS) caused by SARS-associated coronavirus-2. A rare, underreported side effect of hydroxychloroquine and chloroquine is cardiotoxicity. The cardiomyopathy occurs as a result of inhibition of lysosomal enzymes causing lysosomal dysfunction and intra-cellular accumulation of metabolic byproducts in the myocardium, leading to hypertrophy with or without restrictive physiology and resultant conduction abnormalities. Based on our review of 57 reported cases of hydroxychloroquine or chloroquine induced cardiomyopathy, dyspnea was the most common associated symptom. The most common rhythms seen on EKG were as follows: complete heart block (18.75%), right bundle branch block (RBBB) (18.75%). The most common findings on echocardiography were left ventricular hypertrophy (LVH) (54%), systolic dysfunction (48%) and diastolic dysfunction (32%). A definitive diagnosis is established by endomyocardial biopsy which demonstrates the presence of curvilinear inclusion bodies. The outcome following cessation of the offending agent ranges from complete reversal in 45% of the cases to continued progression with need for cardiac transplantation or even death in 17.5% of the cases.
VL  - 7
IS  - 1
ER  -

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Author Information

Pramod Theetha Kariyanna

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA
Andrew Doodnauth

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA
Mrinali Shetty

Division of Cardiology, Department of Internal Medicine, Northshore University Health System, University of Chicago, Chicago, USA
Benjamin Ramalanjaona

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA
Naseem Hossain

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA
Yuvraj Singh Chowdhury

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA
Nimrah Hossain

Department of Internal Medicine, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York, USA
Apoorva Jayarangaiah

Department of Internal Medicine, Albert Einstein College of medicine/Jacobi Medical Center, Bronx, N. Y., USA
Adam Budzikowski

Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Medical Sciences University, Brooklyn, New York, USA

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APA Style

Pramod Theetha Kariyanna, Andrew Doodnauth, Mrinali Shetty, Benjamin Ramalanjaona, Naseem Hossain, et al. (2021). Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. International Journal of Clinical and Experimental Medical Sciences, 7(1), 31-36. https://doi.org/10.11648/j.ijcems.20210701.15

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ACS Style

Pramod Theetha Kariyanna; Andrew Doodnauth; Mrinali Shetty; Benjamin Ramalanjaona; Naseem Hossain, et al. Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. Int. J. Clin. Exp. Med. Sci. 2021, 7(1), 31-36. doi: 10.11648/j.ijcems.20210701.15

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AMA Style

Pramod Theetha Kariyanna, Andrew Doodnauth, Mrinali Shetty, Benjamin Ramalanjaona, Naseem Hossain, et al. Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review. Int J Clin Exp Med Sci. 2021;7(1):31-36. doi: 10.11648/j.ijcems.20210701.15

Copy | Download

@article{10.11648/j.ijcems.20210701.15,
  author = {Pramod Theetha Kariyanna and Andrew Doodnauth and Mrinali Shetty and Benjamin Ramalanjaona and Naseem Hossain and Yuvraj Singh Chowdhury and Nimrah Hossain and Apoorva Jayarangaiah and Adam Budzikowski},
  title = {Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {7},
  number = {1},
  pages = {31-36},
  doi = {10.11648/j.ijcems.20210701.15},
  url = {https://doi.org/10.11648/j.ijcems.20210701.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20210701.15},
  abstract = {Hydroxychloroquine and Chloroquine are commonly used for the treatment of malaria and autoimmune conditions. Most recently, hydroxychloroquine has been implicated in the treatment armamentarium of Severe acute respiratory syndrome (SARS) caused by SARS-associated coronavirus-2. A rare, underreported side effect of hydroxychloroquine and chloroquine is cardiotoxicity. The cardiomyopathy occurs as a result of inhibition of lysosomal enzymes causing lysosomal dysfunction and intra-cellular accumulation of metabolic byproducts in the myocardium, leading to hypertrophy with or without restrictive physiology and resultant conduction abnormalities. Based on our review of 57 reported cases of hydroxychloroquine or chloroquine induced cardiomyopathy, dyspnea was the most common associated symptom. The most common rhythms seen on EKG were as follows: complete heart block (18.75%), right bundle branch block (RBBB) (18.75%). The most common findings on echocardiography were left ventricular hypertrophy (LVH) (54%), systolic dysfunction (48%) and diastolic dysfunction (32%). A definitive diagnosis is established by endomyocardial biopsy which demonstrates the presence of curvilinear inclusion bodies. The outcome following cessation of the offending agent ranges from complete reversal in 45% of the cases to continued progression with need for cardiac transplantation or even death in 17.5% of the cases.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Hydroxychloroquine and Chloroquine Induced Cardiomyopathy: A Concise Review
AU  - Pramod Theetha Kariyanna
AU  - Andrew Doodnauth
AU  - Mrinali Shetty
AU  - Benjamin Ramalanjaona
AU  - Naseem Hossain
AU  - Yuvraj Singh Chowdhury
AU  - Nimrah Hossain
AU  - Apoorva Jayarangaiah
AU  - Adam Budzikowski
Y1  - 2021/02/09
PY  - 2021
N1  - https://doi.org/10.11648/j.ijcems.20210701.15
DO  - 10.11648/j.ijcems.20210701.15
T2  - International Journal of Clinical and Experimental Medical Sciences
JF  - International Journal of Clinical and Experimental Medical Sciences
JO  - International Journal of Clinical and Experimental Medical Sciences
SP  - 31
EP  - 36
PB  - Science Publishing Group
SN  - 2469-8032
UR  - https://doi.org/10.11648/j.ijcems.20210701.15
AB  - Hydroxychloroquine and Chloroquine are commonly used for the treatment of malaria and autoimmune conditions. Most recently, hydroxychloroquine has been implicated in the treatment armamentarium of Severe acute respiratory syndrome (SARS) caused by SARS-associated coronavirus-2. A rare, underreported side effect of hydroxychloroquine and chloroquine is cardiotoxicity. The cardiomyopathy occurs as a result of inhibition of lysosomal enzymes causing lysosomal dysfunction and intra-cellular accumulation of metabolic byproducts in the myocardium, leading to hypertrophy with or without restrictive physiology and resultant conduction abnormalities. Based on our review of 57 reported cases of hydroxychloroquine or chloroquine induced cardiomyopathy, dyspnea was the most common associated symptom. The most common rhythms seen on EKG were as follows: complete heart block (18.75%), right bundle branch block (RBBB) (18.75%). The most common findings on echocardiography were left ventricular hypertrophy (LVH) (54%), systolic dysfunction (48%) and diastolic dysfunction (32%). A definitive diagnosis is established by endomyocardial biopsy which demonstrates the presence of curvilinear inclusion bodies. The outcome following cessation of the offending agent ranges from complete reversal in 45% of the cases to continued progression with need for cardiac transplantation or even death in 17.5% of the cases.
VL  - 7
IS  - 1
ER  -

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