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Cardiac Rehabilitation Participant With Sickle Cell Trait and Statin-Related Hepatotoxicity: A CASE REPORT

Kato, John-David DC, MSc; Wang, Cheng Tao MD, CCFP

Erratum

In the article that appeared on page 182 of the July/August issue, the first 2 sentences of the fourth paragraph of the Discussion section were edited during production and did not convey the correct meaning. The sentences should be replaced with the following text:

Despite the reports of deaths, mortality for most persons with SCT does not appear to be affected.11 Furthermore, the risk of physical activity-related deaths in this group is low. Therefore, to promote the many health benefits of physical activity, moderate intensity exercise can and should be encouraged.

Journal of Cardiopulmonary Rehabilitation and Prevention. 32(5):316, September/October 2012.

Journal of Cardiopulmonary Rehabilitation and Prevention: July/August 2012 - Volume 32 - Issue 4 - p 182–186
doi: 10.1097/HCR.0b013e318255a382
Brief Reports

PURPOSE: Exercise recommendations for patients with sickle cell trait (SCT) and myocardial infarction (MI) are limited. This case report describes such a patient, who subsequently participated in cardiac rehabilitation (CR).

CASE: Patient experienced sudden intense chest pressure and shortness of breath while singing in church. Electrocardiogram and cardiac enzymes confirmed acute ST elevation MI. Laboratory tests indicated hyperlipidemia and elevated liver enzyme levels >4 times the upper normal limit (UNL). Day 40 post-MI, the patient returned to the hospital complaining of daily chest discomfort, atypical for angina pectoris. Following an unremarkable stress test result, the patient was encouraged to proceed with CR. Patient made regular progress through CR, although continued to experience paroxysmal chest discomfort away from CR, which he denied having during exercise. On day 75, his lipid profile met recommended targets while taking atorvastatin, but with liver enzymes >38 times UNL. Atorvastatin was discontinued at day 85, to which his enzymes responded appropriately, but by day 165, hyperlipidemia had returned. Rosuvastatin was started but was discontinued (day 197), with liver enzymes 6 times UNL. He continued CR without lipid therapy but at CR completion, the lipid panel did not meet targets. However, fitness and social indices improved significantly, although he occasionally still experienced chest pain, but with lesser frequency and intensity, and never with exercise.

CONCLUSIONS: CR in a patient with SCT, MI, and statin-related hepatotoxicity requires several specific considerations. Although SCT-exercise associated deaths are described in the literature, this case suggests that such patients can benefit from CR and can exercise safely.

Exercise recommendations in sickle cell trait (SCT) and myocardial infarction (MI) are limited. This case report describes such a patient, who participated in cardiac rehabilitation (CR). CR in patients with SCT, MI, and statin-related hepatotoxicity requires specific considerations. This case suggests these patients can benefit from CR and exercise safely.

Cardiac Wellness and Rehabilitation Centre, Trillium Health Centre, Toronto, Ontario, Canada.

Correspondence: John-David Kato, DC, MSc, Cardiac Wellness and Rehabilitation Centre, Trillium Health Centre, 150 Sherway Dr, Toronto, ON M9C 1A5, Canada (jkato@thc.on.ca).

The authors declare no conflict of interest.

© 2012 Lippincott Williams & Wilkins, Inc.