Doxorubicin Chronic Cardiomyopathy

Abstract

A 54-year-old woman with a history of hypothyroidism, systemic hypertension, and an electrocardiogram showing left ventricular hypertrophy with repolarization abnormality underwent mastectomy and chemotherapy with doxorubicin for carcinoma of the breast with pulmonary metastases. Soon thereafter she became dyspneic, and the dyspnea persisted over the next 6 years despite treatment for cardiac failure.When she was admitted to the hospital at age 60 for worsening cardiac failure, she required inotropic agents for 36 hours. Her neck veins were markedly elevated with large CV waves despite vigorous diuresis. Crackles were heard at both lung bases. Her liver was markedly enlarged and tender, especially the left lobe. She complained that her liver hurt worse when she walked. A huge right ventricular lift was palpable at the left sternal border, and a large dynamic left ventricular impulse could be

Potential Therapeutic Treatments for Doxorubicin-Induced Cardiomyopathy

“…Early manifestations of DIC include chest pain and/or palpitations commonly due to sinus tachycardia, paroxysmal non-sustained supraventricular tachycardia, or premature atrial and ventricular beats [ 4 ]. Electrocardiogram changes such as tall, broad P-waves with a dart-and-dome configuration in lead V1 indicative of bi-atrial enlargement and a QRS complex revealing left bundle branch block with left axis deviation can also be seen in DIC [ 13 ]. However, with the termination of DOX, acute changes unrelated to dosage such as myopericarditis are reversible, and sinus rhythm can be restored [ 13 ].…”

“…Electrocardiogram changes such as tall, broad P-waves with a dart-and-dome configuration in lead V1 indicative of bi-atrial enlargement and a QRS complex revealing left bundle branch block with left axis deviation can also be seen in DIC [ 13 ]. However, with the termination of DOX, acute changes unrelated to dosage such as myopericarditis are reversible, and sinus rhythm can be restored [ 13 ]. A higher incidence of DIC can be seen in patients administered with a higher total dose, children under four years, adults of advanced age, especially females, and those with pre-existing cardiovascular disorders [ 14 ].…”