Chloroquine
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Third-degree atrioventricular block: case report A 67-year-old woman developed third-degree atrioventricular block (AVB) during treatment with chloroquine for rheumatoid arthritis (RA). The woman, who did not have any previous cardiac symptoms, was hospitalised due to shortness of breath, syncope and dizziness. She had been diagnosed with RA in 1987. As a treatment of rheumatoid arthritis, she had been receiving azathioprine for 10 months and oral chloroquine [Emquine] 155mg tablets daily for 3 years. On admission, her pulse rate was found to be 30 beats/min and her BP was found to be 90/60mm Hg. A 12-lead ECG showed a complete third-degree AVB [time to reaction onset not stated]. A transthoracic echocardiography showed no functional or structural abnormality besides a mild mitral regurgitation. Her blood electrolyte levels and cardiac biochemical markers were found to be normal. After initial analysis, a temporary transvenous pacemaker was implanted via the right jugular vein, and therapy with chloroquine was withdrawn. Due to the complete third-degree AVB, her blood creatine levels were found to be increased. The blood creatine level was found to be elevated due to a reduced cardiac output caused by AVB. Therefore, the woman received sodium chloride. On the 3rd day of admission, when the blood creatine level reduced below 1.5 mg/dL, a coronary angiography was performed. In the coronary angiogram, non-critical plaques were noted in the right coronary artery and the left anterior descending artery. Three days later, the third-degree complete AVB spontaneously resolved to sinus rhythm. Methotrexate was initiated instead of chloroquine and azathioprine was maintained. On day 4 of hospitalisation, she was discharged. She did not have any symptoms. An electrocardiography performed 6 weeks after the discharge was found to be normal. Islamoglu Y, et al. Third-degree atrioventricular block due to chloroquine treatment. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi 57: 253-255, No. 4, Jan 2011. Available 803445083 from: URL: http://doi.org/10.4274/tftr.83436
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Reactions 11 Jan 2020 No. 1786
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