We experienced 2 patients of
valvular heart disease in Parkinson's patients taking
cabergoline. Patient 1 was a 79-year-old woman who began taking 4 mg
cabergoline daily after being diagnosed with
Parkinson's disease (PD) in June 2003. She presented with
dyspnea in November 2005. The patient had
cardiomegaly, pulmonary congestion, and
pleural effusion, and an echocardiogram showed
valvular heart disease in the form of
aortic regurgitation (AR) (grade I),
tricuspid regurgitation (TR) (grade I), and
mitral regurgitation (MR) (grade III).
Cabergoline was thought to have caused these phenomena, so it was replaced with
pramipexole, and after administration of
diuretics and
angiotensin-converting enzyme inhibitors (ACEIs) the patient's symptoms gradually disappeared. MR, AR and TR also disappeared 3 months later. Patient 2 was a 74-year-old woman who presented with sluggish movement in April 2001 and subsequently developed Parkinson's. While being administered 700 mg
levodopa (Menesit) and 4 mg
cabergoline, the patient presented with
shortness of breath in April 2005. An echocardiogram showed
valvular heart disease in the form of MR (grade I) and TR (grade I). Heart function improved with the administration of
diuretics. However, heart function again worsened in November 2005, and the patient presented with
edema of the lungs and lower limbs. An echocardiogram in January 2006 showed worsening MR (grade III) and TR (grade II), and the patient also had
pulmonary hypertension. ACEIs were administered along with
diuretics and
cabergoline was replaced with
pramipexole, but the patient also developed malignant syndrome and
disseminated intravascular coagulation (
DIC) and later died. Patient 2 is the first case in Japan of death due to
heart failure caused by the side effects of
cabergoline. Caution is usually needed when treating a Parkinson's patient for
valvular heart disease due to a
dopamine agonist, and periodic checks for
heart murmurs and echocardiography are crucial. When signs of
heart failure develop during treatment with an ergot preparation of
dopamine agonist, it is essential to immediately either stop the administration of the ergot preparation or change to a non-ergot preparation of
dopamine agonist.