Indonesian Journal of

Cardiology
Indonesian J Cardiol 2018:39:suppl_A
pISSN: 0126-3773 / eISSN: 2620-4762
doi: 10.30701/ijc.v38isuppl_A.830
Risperidone-Induced Premature Ventricular Complexes (PVC) in Paranoid Schizophrenia Patient in
Psychiatry Ward Dr Soetomo General Hospital Surabaya: An Evidence Based Case Report

Boby Pratama Putra1, Agus Subagjo2

1
School of Medicine, Universitas Airlangga, Surabaya, Indonesia. 2Department of Cardiology and Vascular
Medicine, Faculty of Medicine Universitas Airlangga - Dr Soetomo General Hospital, Surabaya, Indonesia

Background. Schizophrenia is one of mental health problems with its prevalence is 1.7 per 1000 in
Indonesia. Antipsychotic drugs, such as Risperidone, were used to treat Schizophrenia. However, the use
of antipsychotic drugs may cause heart rhythm disturbances kind of Premature Ventricular Complexes
(PVC) even Ventricular Tachycardia (VT).

Case Illustration. A 45-year-old woman was brought to emergency department after behavioral changes
of getting anger and suspicious feeling. The patient was diagnosed paranoid schizophrenia then
hospitalized in psychiatry ward. The patient was treated with Risperidone 4 mg daily. After 7 days
treatment, the patient was discharged and given the same outpatient drug. About 2 weeks later, the
patient was hospitalized again because of having more paranoid symptoms. The patient also had
palpitation and sometimes felt losing heart beat. At first, the patient was given psychotherapy. However,
the symptoms did not relieve then the patient was consulted to cardiology department. The patient
previously did not have any cardiac problems. The physical examination revealed irregular heart rhythm
without additional heart sound. The electrocardiogram showed normal sinus rhythm with multiple PVCs.
The electrolytes (Na,K,Cl,Ca,Mg) were normal. Bisoprolol 2.5 mg daily was administrated and two days
later the patient did not complain palpitation anymore.

Methods. A literature review was conducted literature searching in Pubmed, Cochrane, and Science
Direct. The keywords used were ‘antipsychotic’ and ‘arrhythmia’ then selected the articles specifically
about PVC.

Discussion. Most antipsychotic drugs include Risperidone block Potassium channel thus inhibit
repolarization, prolong the QT interval and might cause ventricular arrhythmia. Besides, Risperidone also
blocks the alpha-2c receptor that stimulates cardiac effect which may induce PVC. PVC has also been
reported in Schizophrenia patient who received other antipsychotic drugs such as Thioridazine and
Quetiapine. The first choice of PVC therapy is selective beta-blocker such as bisoprolol, because the

Abstracts of the 6th Annual Scientific Meeting of the Indonesian Heart Rhythm Society 2018
71
 Indonesian Journal of
Cardiology
Indonesian J Cardiol 2018:39:suppl_A
pISSN: 0126-3773 / eISSN: 2620-4762
doi: 10.30701/ijc.v38isuppl_A.830
problem is in the heart only. Selective beta-blocker blocks beta-1 adrenergic receptor then causes
automaticity decrease, prolong atrioventricular nodal refractory period, low ventricular responses rate,
and reduce ventricular ectopic beat, thus decreases PVC.

Conclusion. The use of antipsychotic drugs can induce PVC and selective beta-blocker is the first choice of
treatments.

Keywords: Schizophrenia, Risperidone, Arrhythmia, Premature Ventricular Contraction, Beta-blocker.

Abstracts of the 6th Annual Scientific Meeting of the Indonesian Heart Rhythm Society 2018
72