Psychotropics and the Failing Heart: Risperidone Driven Tachycardia Mediated Cardiomyopathy

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Antipsychotic medications like risperidone can cause cardiac issues, including QT prolongation and tachycardia, but heart failure is rare. We report a 23-year-old male with newly diagnosed heart failure with reduced ejection fraction (HFrEF), likely due to risperidone-induced tachycardia-mediated cardiomyopathy. CASE A 23-year-old male presented in March 2025 with shortness of breath and orthopnea. He had schizophrenia treated with risperidone since 2023 and no cardiac family history. Exam showed rales, jugular vein distention, and S3 gallop. EKG revealed sinus tachycardia (rate 130). Labs were normal except for BNP (1,248). Echocardiogram showed 10% ejection fraction with global hypokinesis, no effusion, or valvular disease. The patient reported palpitations since starting risperidone. As prior records confirmed persistent tachycardia (120s) since risperidone initiation and no psychiatric concerns persisted, risperidone was stopped. Tachycardia resolved, and cardiac MRI showed no inflammation, infiltrative disease, or scarring. DECISION-MAKING Although there are currently no case reports of risperidone-mediated cardiomyopathy, tachyarrhythmia-mediated cardiomyopathy is well documented. Furthermore, basic research with mice has shown that the use of atypical antipsychotics led to aberrant cardiac gene expression presenting on histologic analysis prior to changes occurring on pathologic analysis, suggesting that these medications may contribute to adverse cardiac remodeling. The same study also showed that risperidone altered cardiac mitochondrial oxygen consumption, implying that its anticholinergic properties were contributing to tachycardia. CONCLUSION Risperidone likely caused tachycardia leading to cardiomyopathy in this patient, as no other causes were identified through extensive investigation. The causes of nonischemic cardiomyopathy vary greatly and antipsychotic medication-mediated cardiomyopathy represents a rare etiology of HFrEF. Knowledge of this case can help guide clinicians in diagnosing and, subsequently, managing this cardiomyopathy.

Volume

87

Issue

13 Suppl

First Page

A1482

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1482

DOI

10.1016/j.jacc.2026.02.3693

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