Toxin-induced cardiomyopathy: A review and pooled analysis of pathophysiology, diagnosis and clinical management

Abstract

Research on drug-induced cardiomyopathy (CM) has largely focused on medically prescribed drugs due to reduced drug efficacy and complicated patient management. Investigation on other aetiologies – environmental toxins including cardiodepressant agents (ethanol), cardiostimulant agents (cocaine and amphetamine), heavy metals (cobalt, lead, mercury, arsenic, lithium or beryllium) and carbonaceous compounds (carbon monoxide or tetrachloride) have been relatively rarely. However, accumulating clinical data demonstrates that exposure to these environmental toxins has a pathogenic role mostly in populations with extreme dietary deficiency and/or long-term occupational exposure. Animal models of CM used to explore cardiotoxicity of environmental toxins have also heightened the awareness of their potential contributions to the pathogenesis of CM in the absence of any other known cause. Thus, the purpose of this paper is to review published evidence on toxic (non-medical drug) induced CM including a meta-analysis of causative toxins, pathophysiology, diagnosis and clinical management. *Correspondence to: Aref Albakri, St-Marien hospital Bonn Venusberg, Department of Internal Medicine, Bonn, Germany, E-mail: arefalbakri@yahoo. com