Antineoplastics
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Reactions 1314 - 14 Aug 2010 S Antineoplastics Takotsubo cardiomyopathy in an elderly patient: case report A 67-year-old woman with multiple myeloma developed Takotsubo cardiomyopathy during treatment with vincristine, doxorubicin, dexamethasone and zoledronic acid; she subsequently died. The woman was diagnosed with hypoparathyroidism and multiple myeloma and initially received melphalan and prednisolone. However, her bone lesions progressed and she was admitted on 7 June 2007 to receive vincristine, doxorubicin and dexamethasone (VAD) therapy [dosages and routes of administration not stated]. After admission VAD therapy was started. On day 6, she received an IV zoledronic acid 4 mg/body infusion and, that evening, she developed a fever (38°C) [duration of VAD therapy to reaction onset not clearly stated]. Up to this time, she had received zoledronic acid on five occasions [dosages, routes of administration and duration of treatment to reaction onset not stated]. The woman received ceftazidime, but her fever persisted. On day 8, she had a temperature of 39°C and she developed pain in the front of her chest. An ECG revealed ST elevations on leads II, III, aVF and V4–6, base contractions and markedly reduced wall motion from near the ventricular septum to the apex. Acute myocardial infarction was suspected. However, no significant stenosis was evident on coronary angiography and she was diagnosed with Takotsubo cardiomyopathy. She received diuretics and nitrate and her chest pain and breathing improved. However, on day 9, she developed disseminated intravascular coagulation, which triggered multiple organ failure and cerebral haemorrhage and she died. Autopsy revealed fusion on the myocardium from the apex to the ventricular septum, inflammatory cell infiltrates and other myocardial cell changes; findings were consistent with Takotsubo cardiomyopathy. Author comment: It was thought that the Takotsubo cardiomyopathy may have occurred subsequent to infection following chemotherapy, however bacterial cultures were negative and no pathogenic bacteria could be identified. We think that in this case the Takotsubo cardiomyopathy was triggered by factors such as an increase in inflammatory cytokines accompanying infection and physical/psychological stress. Mitsumori T, et al. [Multiple myeloma complicated with Takotsubo cardiomyopathy]. [Review] [14 refs] [Japanese]. Rinsho Ketsueki 51: 291-6, No. 4, Apr 2010 [Japanese; summarised from a translation] - Japan 803030592 1 Reactions 14 Aug 2010 No. 1314 0114-9954/10/1314-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1314 - 14 Aug 2010
SAntineoplastics
Takotsubo cardiomyopathy in an elderly patient:case report
A 67-year-old woman with multiple myeloma developedTakotsubo cardiomyopathy during treatment withvincristine, doxorubicin, dexamethasone and zoledronicacid; she subsequently died.
The woman was diagnosed with hypoparathyroidismand multiple myeloma and initially received melphalan andprednisolone. However, her bone lesions progressed andshe was admitted on 7 June 2007 to receive vincristine,doxorubicin and dexamethasone (VAD) therapy [dosagesand routes of administration not stated]. After admissionVAD therapy was started. On day 6, she received an IVzoledronic acid 4 mg/body infusion and, that evening, shedeveloped a fever (38°C) [duration of VAD therapy toreaction onset not clearly stated]. Up to this time, she hadreceived zoledronic acid on five occasions [dosages, routesof administration and duration of treatment to reactiononset not stated].
The woman received ceftazidime, but her feverpersisted. On day 8, she had a temperature of 39°C and shedeveloped pain in the front of her chest. An ECG revealedST elevations on leads II, III, aVF and V4–6, basecontractions and markedly reduced wall motion from nearthe ventricular septum to the apex. Acute myocardialinfarction was suspected. However, no significant stenosiswas evident on coronary angiography and she wasdiagnosed with Takotsubo cardiomyopathy. She receiveddiuretics and nitrate and her chest pain and breathingimproved. However, on day 9, she developed disseminatedintravascular coagulation, which triggered multiple organfailure and cerebral haemorrhage and she died. Autopsyrevealed fusion on the myocardium from the apex to theventricular septum, inflammatory cell infiltrates and othermyocardial cell changes; findings were consistent withTakotsubo cardiomyopathy.
Author comment: It was thought that the Takotsubocardiomyopathy may have occurred subsequent to infectionfollowing chemotherapy, however bacterial cultures werenegative and no pathogenic bacteria could be identified. Wethink that in this case the Takotsubo cardiomyopathy wastriggered by factors such as an increase in inflammatorycytokines accompanying infection and physical/psychologicalstress.Mitsumori T, et al. [Multiple myeloma complicated with Takotsubocardiomyopathy]. [Review] [14 refs] [Japanese]. Rinsho Ketsueki 51: 291-6, No. 4,Apr 2010 [Japanese; summarised from a translation] - Japan 803030592
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Reactions 14 Aug 2010 No. 13140114-9954/10/1314-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
