Sibutramine-Induced Nonischemic Cardiomyopathy

Abstract

Within the past 20 years, the global pandemic of obesity and associated life-threatening comorbidities significantly promoted the development and intervention of anti-obesity pharmacotherapy. Sibutramine hydrochloride monohydrate, formerly sold under the brand name Meridia and Reductil among others, is an anti-obesity, selective serotonin, and norepinephrine reuptake inhibitor drug that suppresses appetite and reduces body weight in conjunction with lifestyle modifications. However, since 2010, it has been discontinued in a majority of countries such as the United States and European Union due to an associated increase in cardiovascular events such as hypertension, tachycardia, arrhythmias, and myocardial infarction. Thus, this article illustrates a case of sibutramine-induced nonischemic cardiomyopathy, including details of evaluation, management, and monitoring of patient progress. Herein, we present a case report of a 19-year-old male with no prior medical conditions who presented to the emergency department after being found in a state of cardiac arrest (pulseless ventricular fibrillation) with consequent intubation in the field. Upon admission, cardiac catheterization and echocardiography revealed patent coronary arteries with a reduced ejection fraction of approximately 15%-20%. Acute systolic heart failure secondary to nonischemic cardiomyopathy was treated with standard medical management. In addition, due to continued episodes of non-sustained ventricular tachycardia, the patient also underwent a subcutaneous implantable cardioverter-defibrillator (ICD) placement.

Keywords: anti-obesity; cardiomyopathy; dietary supplement; nonischemic; sibutramine.

Figure 1. Coronary angiogram

Coronary arteries are patent, without any morphological abnormalities. A: Right coronary artery (RCA). B: Left main coronary artery and left anterior descending (LAD) artery. C: Left anterior descending artery and left circumflex (LCX) artery. D: Left anterior descending artery and left circumflex artery.

Figure 2. Electrocardiogram

ECG tracing in the hospital shows a normal rate, sinus rhythm, and premature ventricular contraction.