What are common signs of antipsychotic-induced myocarditis and how is it monitored?

• A. Cough and hoarseness; monitor spirometry
• B. Chest pain, tachycardia, shortness of breath, fever; monitor troponin, ECG, echocardiography as indicated; discontinue offending agent if suspected
• C. Rash and pruritus; monitor biopsy
• D. Drowsiness and fatigue; monitor EEG

Answer: (C)

Recognizing antipsychotic-induced myocarditis comes from understanding how it presents in the heart and how we check for heart involvement. The hallmark signs are chest pain, a fast or irregular heartbeat (tachycardia), shortness of breath, and fever, reflecting inflammation of the heart muscle. When these symptoms appear after starting or increasing an antipsychotic, clinicians check for myocardial injury by measuring troponin levels, perform an ECG to detect electrical changes, and use echocardiography to assess how well the heart is pumping if indicated. If myocarditis is suspected, stopping the offending antipsychotic promptly is crucial to prevent further damage.

Rashes and itching point to a skin hypersensitivity reaction rather than myocarditis, and biopsy isn’t a routine monitoring step for this cardiac issue. Drowsiness and fatigue relate to sedation or other CNS effects, not a direct sign of myocarditis, and EEG isn’t used to monitor cardiac inflammation.