Is clozapine the queen of broken hearts? – cardiac complications of clozapine based on a case report

Clozapine – called the queen of neuroleptics – is characterized by its extraordinary effectiveness, which is superior to other drugs from this group. In particular, it is considered the “last resort” drug for patients with treatment-resistant schizophrenia. Unfortunately, clozapine treatment is limited to life-threatening complications, including cardiac ones, which are increasingly the subject of discussion. The article describes the case of a patient who, despite the absence of risk factors, developed symptoms of myocarditis 2 weeks after starting clozapine. The measurement of inflammation markers and troponin in the blood contributed to making a reltively early diagnosis and taking actions to prevent complications. Myocarditis may occur at any time during clozapine treatment, some authors suggest that the first 4 weeks of treatment are the most critical. Therefore, the latest guidelines recommend regular assessment of leukocyte counts and C-reactive protein levels to detect myocarditis during this period. Additionally, it is suggested that the above-mentioned inflammatory markers should be supplemented with blood troponin levels in the first weeks of treatment due to their greater specificity for myocardial pathology. The symptoms of myocarditis completely disappear without serious consequences for health in many patients. The condition is early diagnosis, which is possible thanks to applying of the latest guidelines in everyday practice.