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Stable angina — USMLE Step 2 CK MCQ

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HardInternal MedicineStable anginaUSMLE Step 2 CK

Three weeks after starting clozapine, a man develops fever, chest pain and persistent resting tachycardia. Troponin is 3 times the upper limit of normal, C-reactive protein is 132 mg/L and echocardiography shows new global hypokinesis. What should be done now?

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Correct answer: B — Stop clozapine and arrange urgent cardiology evaluation for myocarditis

The timing, symptoms, marked troponin and CRP elevation, and new ventricular dysfunction strongly support clozapine-induced myocarditis. Clozapine should be stopped and urgent cardiac assessment and supportive heart-failure care arranged. Isolated mild tachycardia can occur during titration, but it cannot explain this cardiac injury pattern. Delayed testing risks deterioration, and beta blockade does not treat inflammatory myocardial injury. Subsequent antipsychotic selection and any exceptional rechallenge require specialist risk-benefit assessment after recovery.

Reference: Management of serious cardiac adverse effects of antipsychotic medications. https://pmc.ncbi.nlm.nih.gov/articles/PMC6007733/