Morning Report: Clozapine-Induced Myopericarditis

Great Discussion at Morning Report today!

  • Clozapine side effects include agranulocytosis, myocarditis, pulmonary embolism, seizures, excessive salivation, urinary incontinence, and constipation
  • Clozapine mediated myocarditis is associated with eosinophilia and biopsy shows eosinophilic infiltrates consistent with an acute drug reaction.
  • The time to onset of clozapine-induced myocarditis is 2-3 weeks after starting Clozapine
  • Four stages of pericarditis on EKG
    • Stage 1: Widespread ST elevation and PR depression
    • Stage 2: Normalization of ST changes, new T wave flattening
    • Stage 3: Inversion of T waves
    • Stage 4: Normalized EKG or persistent T wave inversions
  • Diagnosis of Acute Pericarditis requires at least 2/4 of the following must be present:
    • Typical chest pain
    • Pericardial Friction Rub
    • Suggestive EKG findings (typically widespread ST elevation)
    • New or worsening pericardial effusion
  • Diagnosis of Myopericarditis:
    • Definite Diagnosis of Acute Pericarditis PLUS the following
    • Suggestive symptoms and EKG abnormalities beyond normal variants
    • Absence of other causes
    • Elevated cardiac enzymes, new onset depressed LV function, abnormal imaging

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