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Cardiomyopathy: case report A 56-year-old woman developed dilated cardiomyopathy during treatment with imipramine for bipolar disorder; cardiomyopathy recurred during treatment with amitriptyline. The woman, who had been receiving imipramine [Tofranil] 20 mg/day for about 12 years, was hospitalised for congestive heart failure. Examination revealed bilateral basilar crackles, hepatojugular reflux and peripheral oedema. On ECG, she had a sinus rhythm of 132 beats/min and T-wave inversion in lateral leads. Chest x-rays revealed bilateral pulmonary oedema and a cardio-thoracic ratio of 0.54, and echocardiography showed a dilated left ventricle with diffuse hypokinesia and a left ventricular ejection fraction (LVEF) of 26%. Imipramine was discontinued and the woman started receiving enalapril, furosemide and digoxin. Her condition gradually improved and, about 3 years after her hospitalisation, she had a LVEF of 71%. Her cardiac status had normalised and, about 4 months later, her cardiovascular treatment was discontinued. About 7 years later, the woman started receiving amitriptyline [Elavil] 25 mg/day, increased to 50 mg/day 8 months later, lithium and paroxetine for bipolar disorder relapse. She was again hospitalised for congestive heart failure almost 2 years after starting amitriptyline. On examination, she had biventricular congestive heart failure with a sinus rhythm of 114 beats/min. Echocardiography showed left ventricular dilation with diffuse hypokinesia and an LVEF of 16%. Amitriptyline and lithium were discontinued and lisinopril, furosemide and digoxin were restarted. Her condition rapidly resolved and she remained in New York Heart Association (NYHA) class I with normal echocardiogram on follow-up about 4 years after her second hospitalisation. Briec F, et al. Recurrence of dilated cardiomyopathy after re-introduction of a tricyclic antidepressant. Archives des Maladies du Coeur et des Vaisseaux 99: 801059531 933-935, No. 10, Oct 2006 - France

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Reactions 13 Jan 2007 No. 1134