Cardiomyopathy Following Olanzapine Use in an Octogenarian: A Case Report and Literature Review.

Olanzapine is a widely prescribed second-generation antipsychotic. We report the case of an 81-year-old woman with hypertension, type 2 diabetes mellitus, osteoporosis, and long-term olanzapine use who presented with progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea, lower extremity edema, and palpitations. Transthoracic echocardiography demonstrated four-chamber dilation, global left ventricular hypokinesis, and a reduced left ventricular ejection fraction (LVEF) of 30-35%. Coronary angiography revealed normal coronary arteries. After initiation of guideline-directed medical therapy for heart failure and discontinuation of olanzapine because of suspected drug-associated cardiomyopathy, the patient clinically stabilized. At outpatient follow-up, transthoracic echocardiography demonstrated partial recovery of left ventricular systolic function, with the LVEF improving to 40.77%. This case emphasizes the necessity of considering medication-associated cardiomyopathy in the differential diagnosis of new-onset nonischemic heart failure, particularly in patients receiving long-term antipsychotic therapy. Early recognition of cardiotoxicity and withdrawal of the offending agent may improve clinical outcomes.