Masked Clozapine-induced Cardiomyopathy

A 33-year-old Latin-American woman with a history of psychosis and mood disorder, but no cardiac history or risk factors, presented with heart failure after 6 weeks of clozapine and olanzapine therapy. Her presentation was ambiguous and further complicated by a highly suggestible nature, which delayed the proper diagnosis and treatment. After discontinuing the antipsychotic agents and completing an otherwise negative comprehensive work-up, her heart function significantly improved (left ventricular ejection fraction increased from 38% to 53%). A literature search showed that cardiomyopathy secondary to antipsychotics has been reported but remains poorly understood. This is the second documented case report of clozapine-induced cardiomyopathy in a Latin-American woman.