A young man with acute dilated cardiomyopathy associated with methylphenidate.
An 18-year-old obese man with a body mass index of 40, diagnosed with attention-deficit hyperactivity disorder and treated with methylphenidate (Concerta) was acutely admitted to hospital with hypoxia and dyspnoea. On investigation signs of liver-, renal-, and heart-failure were found. Noradrenalin infusion was started. Echocardiography showed dilated left ventricle and an ejection fraction (EF) of 25%. Liver function improved, noradrenalin and dobutamine were tapered, but three days after admission a new echocardiography showed an EF of 10%. The patient was transferred to the National Hospital (Rikshospitalet, Oslo), where intensified treatment including intra aortic balloon pump (IABP) was instituted. Cardiac function improved, and 3 weeks later the IABP was disconnected. EF at this point was 15%. The patient was denied heart transplantation due to various cofactors. The investigation concluded with a probable relationship between his cardiomyopathy and the use of methylphenidate (Concerta).
Nymark
Tor-Bjarne
TB
Section for Emergency Medicine, Nordland Hospital, Bodø, Norway. tor.bjarne.nymark@nlsh.no
Hovland
A
A
Bjørnstad
H
H
Nielsen
E W
EW
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy*; D002311:Cardiomyopathy, Dilated / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D004280:Dobutamine / Q000627:therapeutic use; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008774:Methylphenidate / Q000009:adverse effects*; D009638:Norepinephrine / Q000627:therapeutic use; D009765:Obesity / Q000150:complications; D013318:Stroke Volume; D013566:Sympathomimetics / Q000627:therapeutic use; D016896:Treatment Outcome
D000697:Central Nervous System Stimulants; D013566:Sympathomimetics; D008774:Methylphenidate; D004280:Dobutamine; D009638:Norepinephrine