Case Report Left Ventricular Thrombus as a Complication of Clozapine-Induced Cardiomyopathy: A Case Report and Brief Literature Review Shahbaz A. Malik, 1 Sarah Malik, 1 Taylor F. Dowsley, 2 and Balwinder Singh 3 1 Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, ND 58102, USA 2 Department of Cardiology, Sanford Health, Fargo, ND 58102, USA 3 Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND 58102, USA Correspondence should be addressed to Balwinder Singh; balwinder.singh@med.und.edu Received 2 July 2015; Accepted 7 November 2015 Academic Editor: Tayfun Sahin Copyright © 2015 Shahbaz A. Malik et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 48-year-old male with history of schizoafective disorder on clozapine presented with chest pain, dyspnea, and new lef bundle branch block. He underwent coronary angiography, which revealed no atherosclerosis. Te patient’s workup was unrevealing for a cause for the cardiomyopathy and thus it was thought that clozapine was the ofending agent. Te patient was taken of clozapine and started on guideline directed heart failure therapy. During the course of hospitalization, he was also discovered to have a lef ventricular (LV) thrombus for which he received anticoagulation. To our knowledge, this is the frst case report of clozapine-induced cardiomyopathy complicated by a LV thrombus. 1. Introduction Clozapine is the most efective antipsychotic agent available for use in treatment resistant schizophrenia [1]. Despite its efcacy, the drug has been associated with serious adverse efects such as fatal agranulocytosis and cardiovascular com- plications (such as myocarditis and dilated cardiomyopathy) [1]. Te former is monitored with the help of regular lab- oratory testing and by enrolling patients in the clozapine registry. However, the cardiovascular side efects still elude early detection. We present this case of dilated, nonischemic cardiomyopathy found in a patient taking clozapine to help bring this potential and gravely morbid complication to light, hopefully, increasing awareness among practitioners. 2. Case Presentation A 48-year-old Caucasian male presented to the emergency department (ED) via local ambulance service, with com- plaints of new onset chest pain and shortness of breath with activity for past two weeks. Te chest pain was present all over the chest, described as a “heavy sensation,” and had signifcantly improved by the time he arrived to the ED with some residual “achiness.” Te pain was nonpleuritic and did not vary with postural changes. He denied any fevers, chills, cough, hemoptysis, calf tenderness, or leg swelling. He had no history of recent viral illnesses, infections, or long distance travel and no family history for premature coronary heart disease or sudden cardiac death. He had no prior reported history of coronary artery disease (CAD). He did have a history of schizoafective disorder for which he was on aripiprazole (15 mg daily), lamotrigine (200 mg daily), benztropine (1 mg 3 times a day), and clozapine (100 mg twice a day). He had no history of smoking or recreational drug use. History at the time of presentation was limited due to patient’s psychiatric condition, as the patient would answer questions in a bizarre fashion. His vitals in the ED revealed a heart rate of 101 beats/min, blood pressure of 95/58 mmHg, and weight of 160 lbs, and saturation was 95% on room air. Positive fndings on physical Hindawi Publishing Corporation Case Reports in Cardiology Volume 2015, Article ID 835952, 5 pages http://dx.doi.org/10.1155/2015/835952