Reactions 1465, p8 - 17 Aug 2013

SAntineoplastics

Decompensated heart failure: case reportA 59-year-old woman with developed acute decompensated

heart failure following chemotherapy for recurrent ovariancancer [routes, dosages and time to reaction onset not stated].

The woman, who had a history of hypertension anddiabetes, underwent abdominal surgery following systemicchemotherapy with paclitaxel, carboplatin, bevacizumab,doxorubicin and cyclophosphamide. She developed coldextremities and discrete knee mottles in the recovery room.Due to oliguria during surgery and anuria postoperatively, shewas transferred to the ICU. Her urine output was<0.5 mL/kg/h. Laboratory investigations included thefollowing: chloride 114mM, bicarbonate 12mM, AST 245U,ALT 257U, troponin T 0.223 µg/L, urine neutrophil gelatinase-associated lipocalin 353 ng/mmol urine creatinine, cystatine C1 mg/L, urine α-1 microglobulin 90 mg/L and fraction excretionof urea 29%. Her central venous pressure was 24mm Hg, withcentral venous oxygen saturation of 66%. Transthoracicechocardiography demonstrated severe left ventriculardysfunction, right ventricular dilation and global hypokinesia.She had a left ventricular ejection fraction (LVEF) of 25%, lowcardiac output (2 L/min), systolic pulmonary arterial pressureof 30mm Hg and a brain natriuretic peptide level of1244 ng/mL.

Following administration of epinephrine [adrenaline], thewoman’s central venous pressure decreased to 15mm Hg, hercentral venous oxygen saturation increased to 88% and hercardiac output increased to 4.5 L/min. Treatment withfurosemide led to increased urine output, and she wasdischarged from the ICU after 5 days. Two months later, acardiac MRI revealed global hypokinesia with an LVEF of 21%.A diagnosis of acute decompensated heart failure due tochemotherapy toxicity was made.

Author comment: "The final diagnosis was acutedecompensated heart failure due to chemotherapy toxicityafter major abdominal surgery complicated by AKI [acutekidney injury]."Legrand M, et al. Case scenario: Hemodynamic management of postoperativeacute kidney injury. Anesthesiology 118: 1446-1454, No. 6, Jun 2013. Availablefrom: URL: http://dx.doi.org/10.1097/ALN.0b013e3182923e8a -France 803091379

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Reactions 17 Aug 2013 No. 14650114-9954/13/1465-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved