Subacute Cardiomyopathy Due to Statin Treatment: Can It Be True?—Case Report and Literature Review

Figures

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  Figure 1. (A) Admission ECG shows sinus rhythm (HR 58 bpm), ST depression and deep negative T waves in V2–V6, generalized T wave inversion, q waves in the inferior leads, narrow QRS, no conduction disorders, left ventricular hypertrophy (Sokolow–Lyon index > 35 mm), and prolonged QTc (616 ms). (B) Day 7 ECG: sinus rhythm (HR 58 bpm), mild ST elevation (<0.5 mm) in V2, persistent but less pronounced negative T waves in V2–V6 and lateral leads, q waves in inferior leads, Sokolow–Lyon index of 37 mm, and QTc 500 ms. (C) Six-month follow-up ECG: sinus rhythm (HR 60 bpm), persistent q waves in inferior leads, and negative T waves in V4–V6.

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  Figure 2. CK levels from day 1 to day 9 of admission. A progressive and substantial decline in CK levels was observed following the discontinuation of atorvastatin, consistent with recovery from muscle injury.

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  Figure 3. Timeline of symptom onset, atorvastatin treatment, clinical course, and biochemical markers. Atorvastatin at 80 mg/day was initiated one month prior to admission. The patient developed walking difficulties two weeks before admission, progressing to severe tetraparesis and orthopnea at presentation. Atorvastatin was discontinued upon admission. CK levels decreased from 25,808 U/L at admission to 397 U/L at discharge and had normalized by 6-month follow-up (121 U/L). NT-proBNP was elevated at admission (2059 pg/mL). Full neurologic and cardiac recovery was achieved in 6 months.

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  Figure 4. hs-Tn levels from day 1 to day 9. A gradual decrease in troponin levels was observed during hospitalization, followed by a mild rebound on days 7–9. This dynamic may reflect partial cardiac involvement with subsequent recovery after statin discontinuation.