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Hydroxychloroquine-induced restrictive cardiomyopathy: a case report
  1. Muhammad U Dogar1,
  2. Niel N Shah2,
  3. Sameera Ishtiaq3,
  4. Parin N Shah4,
  5. Pratik Shah5,
  6. Shawn Mathew6,
  7. Timothy J Vittorio7
  1. 1 Department of Medicine, Crozer-Chester Medical Center, Chester, Pennsylvania, USA
  2. 2 Intern, Smt N. H. L. Municipal Medical College, Ahmedabad, Gujarat, India
  3. 3 Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, New York, USA
  4. 4 Department of Biochemistry, B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
  5. 5 Medical Student, Hofstra University, Hempstead, New York, USA
  6. 6 Medical Student, New York Institute of Technology, Old Westbury, New York, USA
  7. 7 Department of Medicine, Division of Cardiology, Bronx-Lebanon Hospital Center, Bronx, New York, USA
  1. Correspondence to Dr Timothy J Vittorio, Department of Medicine, Division of Cardiology, Bronx-Lebanon Hospital Center, Bronx, NY 10457, USA; tjvittorio{at}gmail.com

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Case presentation

A man in his 60s presented to our clinic for worsening exercise capacity, dyspnoea on exertion for 18 months and chest pain not associated with exercise. He had medical history of rheumatoid arthritis (RA), Sjogren’s syndrome, Raynaud’s phenomenon, gastro-oesophageal reflux, dyslipidaemia and Parkinson’s disease. He was on hydroxychloroquine (HCQ) for RA at the time of presentation. A nuclear stress test was normal. Cardiac angiogram showed left ventricular ejection fraction of 55%, normal coronary arteries, normal systolic pulmonary pressure but elevated left ventricular end-diastolic pressure, right atrial pressure, pulmonary capillary wedge pressure and right ventricular end-diastolic pressure, which were compliant with diastolic dysfunction and possibly infiltrative cardiomyopathy.

Two-dimensional (2D) echocardiogram showed left ventricular relaxation abnormality and pulmonary hypertension. Cardiac MRI (CMR) showed thin myocardial wall with basement …

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