Table 6: Toxins associated with cardiomyopathies
| Toxin: Alcohol |
| Causes |
Excessive alcohol use.
Heavy drinking: for women more than 1 drink per day and for men more than 2 drinks per day.
Binge drinking: for women more than 3 drinks and for men more than 4 drinks |
| Symptoms and signs |
| Symptoms and signs of heart failure and/or chronic liver disease |
| Diagnosis |
| Detailed history, blood level |
| Treatment |
| Abstaining from alcohol; usual heart failure medications |
| Toxin: Illicit drugs and medications |
| Causes |
| History of drug or chemotherapy use. May be related to the dose and duration. Includes herbal, nutraceutical and alternative therapies |
| Symptoms and signs |
| Symptoms and signs of heart failure. |
| Diagnosis |
| Careful history taking of present or previous use of prescribed and over-the-counter medications |
| Treatment |
| Discontinue the drug; supportive measures; Usual heart failure medications
|
| Toxin: Cocaine Metamphetamine, antidepressants, corticosteroids, anabolic steroids, phenothiazines |
| Symptoms and signs |
| Cocaine may cause thrombosis, coronary spasm, chest pain and myocardial infraction. May also cause myocarditis and aortic dissection |
| Diagnosis |
| Prior or recent history of cocaine use; urinary metabolites |
| Treatment |
| Calcium channel blockers may be useful in cocaineinduced chest pain or coronary spasm |
| Toxin: Chemotherapy13 Anthracycline (doxorubicin, daunorubicin), bleomycin, adriamycin; cyclophosphamide; cytostatic agents; interferons, interleukin-2 Trastuzumab |
| Causes |
| Cardiotoxic drugs used to treat cancer |
| Symptoms and signs |
| Symptoms and signs of heart failure. Symptoms, signs or history of malignancy |
| Diagnosis |
| Prior history of malignancies with chemotherapy. May need myocardial biopsy. |
| Treatment |
| Standard heart failure treatment may reverse the abnormalities. Avoid using these agents again |
| Toxin: Heavy metals (cobalt, chromium, mercury, phosphorus, iron, gold, silver) |
| Causes |
| Outbreaks of cardiomyopathy occurred among heavy consumers of cobalt fortified beer |
| Diagnosis |
| The two main target organs are the skin and the respiratory tract. Cobalt itself may cause allergic dermatitis, rhinitis and asthma |
| Treatment |
| Avoid exposure. Usual heart failure treatment |
| Toxin: Herbal |
| Causes |
| Chinese herbal mixture, blue cohosh |
| Symptoms and signs |
| Symptoms and signs of heart failure |
| Diagnosis |
| History of herbal product use |
| Treatment |
| Standard heart failure treatment |
| Toxin: Radiation |
| Causes |
| Radiation may cause microcirculatory damage, interstitial fibrosis, accelerated atherosclerosis |
| Symptoms and signs |
| Symptoms and signs of diastolic heart failure |
| Diagnosis |
| History of radiation |
| Treatment |
| Standard heart failure treatment. Avoid further radiation |