January 27, 2023

Kolkrun i am a fourth year medical student at rush medical college this is a poster presentation on the association between dilated cardiomyopathy and methylphenidate so for some background heart failure due to idiopathic dilated cardiomyopathy is rare in younger patients these patients are often found to have genetic linkage or cytotoxic drug exposure and

While cocaine and amphetamines have known correlation to the development of dilated cardiomyopathy methylphenidate does not so we report a case of a young man with fragile x syndrome who develops heart failure with reduced ejection fraction after a long term methylphenidate use so this is a 41 year old male with fragile x syndrome and obesity he’s admitted to

The general medicine floor for an acute exacerbation of chronic heart failure he had previously been taking methylphenidate 20 milligrams three times daily for decades prior to hospital admission upon heart failure diagnosis six months prior to this admission methylphenidate was discontinued as other stimulants have been implicated in the development of dilated

Cardiomyopathy and otherwise healthy individuals so this patient was diagnosed with combined diastolic and systolic heart failure six months prior to presentation tte at that time revealed by ventricu biventricular dysfunction left ventricular ejection fraction of 20 to 25 percent severe dilation of all four cardiac chambers mild aortic root dilation and mild to

Moderate mitral valve regurgitation he was started on gdmt therapy for new york heart association class 2 to 3 stage c heff ref likely secondary to non-ischemic dilated cardiomyopathy these images below are the echo findings from his hospitalization six months after his original diagnosis and they show a severely dilated heart so fragile x syndrome is commonly

Associated with well-defined cardiac abnormalities abnormalities such as mitral valve prolapse and aortic root dilation over 55 percent of patients with fragile x have mvp and roughly 20 percent of patients over age 18 have abnormal aortic root dimensions however there’s a lack of literature describing the prevalence of patients with fragile x who are diagnosed

With heart failure with etiologies other than mvp or aortic root dilation as seen in this patient ultimately methylphenidate was pursued as the cause of this patient’s heart failure methylphenidate is the cns stimulant that increases the release of catecholamines and blocks their synaptic reuptake reuptake and degradation circulating catecholamines activate beta

1 and alpha receptors leading to increased systolic blood pressure and heart rates risk both are risk factors for adverse cardiac events when elevated while there’s conflicting literature discussing that the specific adverse cardiac effects associated with stimula use in the adult population multiple studies have confirmed that there is a statistically significant

Increase in systolic blood pressure and heart rate in both adults and children on long-term stimulants though these changes may seem minimal and healthy individuals there are no guidelines to identify patients who are at a higher risk of developing cardiac toxicity from stimulants for this patient obesity is associated with increased sympathetic nervous system

Activation and hyperdynamic circulation with increased cardiac output thus amplifying the stimulant cns response even further while this may represent one possibility further research needs to be done to properly identify those who may be more prone to experiencing these cards

Transcribed from video
The Association Between Dilated Cardiomyopathy and Methylphenidate By Nicole Cornet