RESUMEN
Schizoaffective disorder, bipolar type is a chronic mental health disorder that may manifest as mania. Clozapine is effective in treating acute mania and in achieving mood stabilization. However, on rare occasions, the use of clozapine has been associated with cardiotoxicity. Here, we present a case of a 31-year-old man who at baseline is known to have schizoaffective disorder, bipolar type, and cannabis dependence and was admitted to our hospital with a psychotic relapse. He was treated with clozapine, uptitrated to a maximum daily dose of 200mg twice daily by day 10. Thereafter he became febrile and experienced malaise, myalgias, and chest pain. He was noted on electrocardiogram to have sinus tachycardia without ischemic changes. In this context, he had a troponin leak, increased white blood cell count, serologies and cultures were negative and chest x-ray revealed no acute disease of the chest. Due to the suspicion of clozapine-induced cardiotoxicity, a transthoracic echocardiogram was done, which revealed mildly depressed left ventricular (LV) systolic function without pericardial effusion. Thereafter, clozapine was withdrawn and switched to lithium. Additionally, the cardioselective, metoprolol tartrate was initiated. Within 36-48 hours, he had resolution of symptoms and remained cardiovascularly stable. Clozapine uncommonly causes cardiotoxicity and early features may be non-specific. Awareness of this and recognizing early features aids in reducing the associated cardiovascular morbidity and mortality.
RESUMEN
Acute cerebral injuries are often accompanied by sudden electrocardiogram (ECG) changes such as cardiac arrhythmias, QT prolongation, and abnormal T-wave morphology. One rare phenomenon is "cerebral T-waves", which are T-waves observed in the context of stroke and described as transient, symmetric, and deeply inverted. The classic cerebral T wave is defined as a T-wave inversion of ≥5 mm depth in at least four contiguous precordial leads, and it is more commonly observed in the setting of acute ischemic stroke rather than hemorrhagic stroke. We describe the case of a patient who initially presented with acute pulmonary edema, T-wave inversions in the precordial leads, and left ventricular dysfunction on echocardiogram raising suspicion of an ischemic cardiac event. However, a brain CT scan performed on the third day of admission proved us wrong.
RESUMEN
[This retracts the article DOI: 10.7759/cureus.10185.].
RESUMEN
Acute cerebral injuries have been repeatedly correlated with sudden and different electrocardiogram (EKG) changes, such as cardiac arrhythmias, QT prolongation, and abnormal T-wave morphology. One rare phenomenon is "cerebral T-waves," which are T-waves observed in the context of stroke and described as transient, symmetric, and deeply inverted. Moreover, few studies linked acute cerebral injuries with transient cardiac dysfunction secondary to autonomic dysfunction. The classic cerebral T-waves are defined as a T-wave inversion of ≥5 mm depth in ≥4 contiguous precordial leads, and it is more commonly observed in the setting of acute ischemic stroke rather than hemorrhagic stroke. We present a patient who presented with acute pulmonary edema, T-wave inversions in the precordial leads, and left ventricular (LV) dysfunction initially suspicious for acute coronary syndrome (ACS). However, computer tomography of the brain performed on the third day of his hospital stay proved us wrong.
