Chemotherapy induced cardiomyopathy case presentation.

1. KAMC
“ ONCO – CARDIOLOGICAL & CARDIO - ONCOLOGICAL SYNDROMES “
“ Malignancy Begets Malignancy “
DR ASADULLAH KHAN SOOMRO
ADULT CARDIOLOGIST
KING ABDULLAH MEDICAL CITY HOLY MAKKAH
Heart Failure & Cancer
“ Dual Epidemics “

2. Case no 2
Chemotherapy Induced Cardiomyopathy
( Chronic transitional phase of advanced HF )

3. 55 year male father of 6 children ,unemployed, no
athero-thrombotic risk factors.
Was diagnosed to had non Hodgkins Lymphoma in
2000.
Received chemotherapy, and in 2003 presented
with symptoms of heart failure and was diagnosed
to have had chemotherapy induced
cardiomyopathy EF 30%.
KAMC,
Cardio-oncological syndromes

4. Subsequently in 2004 under went bone marrow transplant, and
worked up for Heart transplant at USA, and was finally
discharged with CRTD implantation.
Remained compensated on guide line directed medical
therapies and remain under follow up at United State and
KFSH Riyadh.
In 2018 reevaluated for advanced therapies, therefore
underwent right heart study and was considered fit for
transplant /LVAD.
KAMC,
Cardio-oncological syndromes

5. In February 2019 ,admitted in Riyadh with
ADCHF and severe MR ,with new A fib, EF 35%,
considered suitable for & under went mitral
valve clip implantation.
In June 2019 readmitted with ADCHF and
received ionotropes to improve organ
perfusion ( renal ,passive liver congestion )
KAMC,
Cardio-oncological syndromes

6. He was referred to KAMC screening clinic by
infectious disease colleague on 15th October
2019.
He was in compensated phase of heart failure
stage C transition to stage D, FC11 with
persistently high BNP, ( BNP,968, Creatnine 1.5
,Na 135,K 4.5,Hb 9.1, Liver function & albumin
normal) EKG sinus rhythm, old LBBB.
KAMC,
Cardio-oncological syndromes

7. Last Echo done on 27th Oct 2019, showed
moderately dilated LA & LV with severe global
dysfunction EF 25 -30%,normal RV size and
function, ICD lead in RV, Mitral valve Clip in situ
with severe MR, mild to moderate TR RSVP =40-
45mm.
Compensated clinically on medical treatment.
KAMC,
Cardio-oncological syndromes

8. Brief discussion
These are two extremes of (CCMP) heart failure, first
one rapidly progressed to advanced heart failure stage D
& E bypassing other stages of heart failure ,therefore
we name this as an malignant
( tiger )heart failure, she survived from cancer but
killed by cancer cured therapy during ,index HF
hospitalization before receiving advanced therapies.
KAMC,
Cardio-oncological syndromes

9. 2nd patient had the similar story but passed through different stages
of heart failure phases and is still living in transitional phase of
stage D heart failure for the last 17 years.
After listening the long journey of this HF gentleman I consider this as an
benign heart failure ( Big Elephant heart ) .
I think its an old statement as heart failure is a malignant
syndrome, but with the advancement in device therapies and new
medication especially after results of new game changer medication
( Sacubitril) this term may be changed to a complex rather then
malignant syndrome.
KAMC,
Cardio-oncological syndromes

10. THANK YOU