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Beyond Expectations: A Case of Doxorubicin-Induced Cardiomyopathy at a Remarkably Low Cumulative Dose.

Anthracycline and its associated cardiotoxicity have been well-established in the literature. With decades of use of anthracycline for a variety of cancer treatments and increased cancer survivability, a detailed study on its cardiac effects is in the continuum. Higher doses of anthracyclines were previously considered the only responsible factor for cardiomyopathy, leading to congestive heart failure. These concepts are now gradually changing to subclinical cardiac changes that even occur at a dosage of 450 mg/m2 or less, which was considered safe previously. Here, we present a case of a 64-y…

Reversible Systolic Heart Failure in a Patient on Ibrutinib Chemotherapy.

Ibrutinib is an irreversible Bruton tyrosine kinase inhibitor that is approved for the treatment of mantle cell lymphoma, chronic lymphocytic leukemia, small lymphocytic lymphoma, Waldenström macroglobulinemia, marginal zone lymphoma, and mantle cell lymphoma. However, it is associated with significant cardiotoxic effects, with hypertension and atrial fibrillation being the most common. We present the case of a 42-year-old female with a medical history significant for lymphoplasmacytic lymphoma who presented with non-arrhythmic, non-ischemic cardiomyopathy after four months of chemotherapy wit

Venous-arterial extracorporeal membrane oxygenation support for patients poisoned by Macleaya cordata.

Macleaya cordata is a Chinese herbal medicine containing a variety of highly cardiotoxic alkaloids, and might result in cardiac failure. Venous-arterial Extracorporeal membrane oxygenation (VA-ECMO) could be used as a therapeutic option in patients poisoned by Macleaya cordata complicating refractory cardiogenic shock or cardiac arrest. A 60-year-old man suffered from severe arrhythmia, cardiogenic shock and cardiac arrest after consuming Macleaya cordata. The patient received VA-ECMO support in the emergency department at 5 hours after hospitalization, and was weaned from VA-ECMO on day 4, an

Resistant Polymorphic Ventricular Tachycardia in a Patient Taking Raspberry Ketones Weight Loss Supplement.

A 32-year-old female with no cardiac risk factors was admitted for treatment of a perianal abscess. During her hospital stay, she had a pulseless electrical activity arrest with a return of spontaneous circulation after one round of cardiopulmonary resuscitation (CPR). After transfer to the Intensive Care Unit (ICU), the patient had polymorphic ventricular tachycardia (PVT) requiring defibrillation shock. Her PVT was resistant to medical interventions. She was shocked a total of 33 times before her arrhythmia was terminated by passing a temporary transvenous pacemaker with overdrive pacing. Af

Short exposure to glyphosate induces locomotor, craniofacial, and bone disorders in zebrafish (Danio rerio) embryos.

Glyphosate [N-(phosphonomethyl)glycine] is the active ingredient in widely used broad-spectrum herbicides. Even though the toxicity mechanism of this herbicide in vertebrates is poorly understood, evidence suggests that glyphosate is an endocrine disruptor capable of producing morphological anomalies as well as cardiotoxic and neurotoxic effects. We used the zebrafish model to assess the effects of early life glyphosate exposure on the development of cartilage and bone tissues and organismal responses. We found functional alterations, including a reduction in the cardiac rate, significant chang

Snakebite Envenomation and Heart: Systematic Review.

Snakebite envenomation is a neglected tropical disease which can result in morbidity and mortality. Cardiac implications are poorly understood due to the low frequency of cardiotoxicity combined with a lack of robust information, as snakebites commonly occur in remote and rural areas. This review aims to assess cardiovascular implications of snakebite envenoming and proposes an algorithm for screening of cardiovascular manifestations. A systematic review was performed and 29 articles relating to cardiovascular involvement in snakebite envenomation were selected. Cardiovascular involvement seem…

A case series about the favorable effects of sacubitril/valsartan on anthracycline cardiomyopathy.

Anthracyclines are the cornerstone of treatment for many solid and hematological cancers such as breast cancer or lymphoma for the past 50 y … uating the potential role of sacubitril/valsartan as a novel therapeutic tool against anthracycline cardiotoxicity.

Proteomics Analysis of Trastuzumab Toxicity in the H9c2 Cardiomyoblast Cell Line and its Inhibition by Carvedilol.

OBJECTIVE: Heart dysfunctions are the major complications of trastuzumab in patients with Human Epidermal growth factor Receptor-2 (HER2)-po … and reversed by carvedilol. These findings provide novel insights to develop new strategies for the cardiotoxicity of trastuzumab.

Bidirectional Relationship Between Cancer and Heart Failure: Old and New Issues in Cardio-oncology.

The main focus of cardio-oncology has been the prevention and treatment of the cardiac toxicity of chemotherapy and radiotherapy. Furthermore, several targeted therapies have been associated with unexpected cardiotoxic side-effects. Recently, epidemiological studies reported a higher incidence of cancer in patients with heart failure (HF) compared with individuals without HF. On this basis, it has been proposed that HF might represent an oncogenic condition. This hypothesis is supported by preclinical studies demonstrating that hyperactivation of the sympathetic nervous system and renin-angiot

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… Chemotherapy- and Radiotherapy-induced Heart Failure Anthracyclines, a class of chemotherapeutic agents commonly used for the treatment of solid and haematologic malignancies, were the first antineoplastic drugs for which a cardiotoxic effect was recognised.[ 14 ] Anthracycline cardiotoxicity may manifest … Identification of the molecular basis of doxorubicin-induced cardiotoxicity. Nat Med. 2012;18:1639–42. doi: 10.1038/nm.2919. 21. Lyu YL, Kerrigan JE, Lin CP et al. Topoisomerase IIbeta-mediated DNA double-strand breaks: implications in doxorubicin cardiotoxicity and prevention by dexrazoxane. …

Immune Checkpoint Inhibitor-Associated Pericarditis.

Side effects of immune checkpoint inhibitors, termed immune-related adverse events, are relatively common, but immune checkpoint inhibitor-mediated cardiotoxicities are rare; however, they can be serious and potentially fatal. Pericarditis is an infrequent cardiac toxicity of immunotherapy and predisposing factors remain unknown. Here we report three patients with NSCLC who developed pericarditis during therapy with programmed death 1/programmed death ligand 1+/- CTLA-4 inhibitors. We review the clinical presentation of these three cases and histopathologic findings from autopsies from the fir

Management of the Cardiovascular Complications of Substance Use Disorders During Pregnancy.

PURPOSE OF REVIEW: Substance use disorder in pregnancy and subsequent cardiovascular complications are on the rise in the USA. The care of p … ons, both as a direct effect of acute intoxication as well as the secondary risk from infection and cardiotoxicity associated with chronic use. This risk must be considered in the antepartum management, delivery, and postpartum periods. Understanding the increased cardiovascular risk of pregnant women with substance use disorder, as well as specific drug interac …

Endocarditis in the setting of HIV infection.

BACKGROUND: Cardiac complications are becoming more important in patients with HIV infection. The most common is infective endocarditis (IE) in patients who are intravenous drug addicts (IVDA). Other less common problems are pulmonary hypertension, cardiotoxicity, pericardial effusion, cardiac neoplasms, etc. PATIENTS AND METHODS: A literature review of published studies on IE was done and the personal experience of the authors is reflected. RESULTS: The clinical pattern of IE has remained unchanged. It is usually due to Staphylococcus aureus and is more commonly localized to the right side …

Economic analyses of toxicity secondary to anthracycline-based breast cancer chemotherapy.

Doxorubicin (D) is one of the most active agents in the treatment of breast cancer but can be associated with cardiotoxicity (CT) and febrile neutropenia (FN). Epirubicin, a stereoisomer of doxorubicin, is reported to have similar efficacy but reduced toxicity. A retrospective chart audit was performed to estimate the incidence, average length of hospitalisation and resource consumption for the management of CT and FN in 200 patients breast cancer patients receiving equidoses of doxorubicin or epirubicin. Overall, there were three more episodes of CT in the doxorubicin group than in epirubicin…

Anti-shock actions of the pyrimido-pyrimidine derivative, RA-642.

The anti-shock actions of RA-642 were studied in traumatic shock in rats. The shock state was characterized by a significantly reduced mean arterial blood pressure (MABP), a five-fold increase in plasma cathepsin D activity, a three-fold increase in plasma myocardial depressant factor (MDF) activity, and a mean survival time of 1.6 +/- 0.3 h. Administration of 0.5 mg/kg of the pyrimido-pyrimidine derivative, RA-642, significantly prolonged survival time to 3.7 +/- 0.6 h (p less than 0.01). Plasma cathepsin D activity was not affected by RA-642 although accumulation of the cardiotoxic peptide M

Chemotherapy for the systemic mycoses: the prelude to ketoconazole.

Successful chemotherapy of the systemic mycoses now covers a span of more than 75 years and dates to the first reported use of potassium iod … atients are not monitored and controlled closely, the drug produces hypokalemic muscle weakness and cardiotoxicity. Flucytosine has a narrower spectrum of activity (cryptococcosis, candidosis, cladosporiosis, and chromomycosis) but a preferable route of administration (oral). Newer agents presently available are miconazole and clotrimazole; the latter is for top …

Minoxidil for severe hypertension after failure of other hypotensive drugs.

Forty-four patients with severe hypertension who were resistant to treatment with more conventional hypotensive drugs or could not tolerate the side effects were treated with minoxidil, a potent peripheral vasodilator. A beta-blocking drug and a diuretic were used routinely to control, respectively, the tachycardia and fluid retention caused by minoxidil. During treatment the outpatient supine blood pressure fell from a mean of 221/134 mm Hg to 162/98 mm Hg. Eleven patients required additional or alternative hypotensive agents before blood pressure was adequately controlled. Side effects were

Prolonged Tricyclic Antidepressant Toxicity in a Pediatric Patient: The Importance of Understanding the Multifactorial Nature of Amitriptyline Metabolism.

Tricyclic antidepressant (TCA) overdose is a potentially life-threatening condition characterized by anticholinergic, cardiotoxic, and neuro … Scale (GCS) score of 3, tachycardia, respiratory distress, and electrocardiographic evidence of TCA cardiotoxicity, including a wide complex tachycardia and QRS prolongation. She required emergent intubation, sodium bicarbonate therapy, seizure prophylaxis, serial electrocardiograms, laboratory monitoring, and intensive care monitoring. Despite appropriate suppo …

High-Sensitivity Troponin T as a Prognostic Factor of Conventional Echocardiographic Parameters in Cancer Patients: A Prospective Observational Study.

Background and Objectives: Cardiac injury caused by cancer therapy can be detected early using high-sensitivity cardiac troponins (hs-cTns), … eline, influenced by anthracycline treatment (p = 0.009), renal function (p = 0.003), and increased cardiotoxicity risk (high: p = 0.013; medium: p < 0.001). Elevated hs-cTnT levels independently predicted the deterioration of the LV longitudinal myocardial function, measured by the systolic tissue velocities, according to the GEE analysis. The receiver operatin …

[Peripartum cardiomyopathy: a little known disease].

Peripartum cardiomyopathy (PPCM) is a relatively rare cardiac disease that manifests itself in the final stage of pregnancy and in the first months after delivery in women with no previous history of cardiovascular disease. The incidence of PPCM varies widely across geographic areas and seems to be on the rise as a result of increased awareness and socioeconomic changes. PPCM recognizes a still partially undefined multifactorial etiology. Various pathogenetic hypotheses have been proposed, that range from autoimmune mechanisms to myocarditis to the hormonal hypothesis for aberrant, antiangioge

Rationale and Design of the Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes: The SUCCOUR Trial.

OBJECTIVES: This study sought to evaluate the hypothesis that global longitudinal strain (GLS) guidance of cardioprotective therapy would improve cardiac function of at-risk patients undergoing potentially cardiotoxic chemotherapy, compared with usual care. BACKGROUND: The conventional criteria for diagnosis of chemotherapy-related cardiac dysfunction (CTRCD) are dependent on the recognition of heart failure symptoms and/or changes in left ventricular ejection fraction. However, the measurement variability of left ventricular ejection fraction necessitates broad diagnostic ranges, with the co