Ново дијагостицирана атријална фибрилација кај пациентка со активен карцином на дојка: тераписки предизвик - приказ на случај
Date Issued
2023-10
Author(s)
Abstract
Breast cancer is the most common malignant disease in females. The specific cancer
treatment protocol involves drugs with known cardiovascular toxicity. Patients with significant
risk of cancer therapy-related cardiovascular toxicity (CRT-CVT) should be reported for
cardiology referral.
CASE REPORT: Seventy-year-old, obese patient with a previous history of hypertension and
low normal left ventricular ejection fraction (LVEF) was diagnosed with breast cancer and
scheduled for baseline assessment before initiating cardiotoxic cancer treatment protocol.
Regular monitoring for an already high-risk patient for CRT-CVT was not enough for
developing of first diagnosed, paroxysmal, asymptomatic atrial fibrilation after completing the
4
th cycle of anthracyclines and total cumulative dose of 208.3mg/m2. Transthoracic
echocardiography did not reveal significant changes in LVEF and global longitudinal strain, so
cancer therapy-related cardiac dysfunction was not the related diagnosis. Laboratory
measurements of cardiac biomarkers did not confirm subclinical cardiac injury. Besides ACEinhibitors already prescribed for hypertension, drugs for rate control and anticoagulation therapy
with both low-molecular-weight heparin and NOAC was the preferred therapeutic decision for
successful completion of the oncological treatment. After a week, the electrocardiogram showed
sinus rhythm. The patient also completed left-sided radiotherapy with total tumor dose of
41,25Gy, and six months after has stabile cardiac performances and normal sinus rhythm.
CONCLUSION: CRT-CVT is the second leading cause of death in breast cancer patients.
Management of the adverse effects is challenging and complex due to the imperative of
completing the cancer therapy and frequent drug-drug interactions. Early detection,
multidisciplinary approach and close monitoring are the cornerstone for overall good outcome in
these patients.
treatment protocol involves drugs with known cardiovascular toxicity. Patients with significant
risk of cancer therapy-related cardiovascular toxicity (CRT-CVT) should be reported for
cardiology referral.
CASE REPORT: Seventy-year-old, obese patient with a previous history of hypertension and
low normal left ventricular ejection fraction (LVEF) was diagnosed with breast cancer and
scheduled for baseline assessment before initiating cardiotoxic cancer treatment protocol.
Regular monitoring for an already high-risk patient for CRT-CVT was not enough for
developing of first diagnosed, paroxysmal, asymptomatic atrial fibrilation after completing the
4
th cycle of anthracyclines and total cumulative dose of 208.3mg/m2. Transthoracic
echocardiography did not reveal significant changes in LVEF and global longitudinal strain, so
cancer therapy-related cardiac dysfunction was not the related diagnosis. Laboratory
measurements of cardiac biomarkers did not confirm subclinical cardiac injury. Besides ACEinhibitors already prescribed for hypertension, drugs for rate control and anticoagulation therapy
with both low-molecular-weight heparin and NOAC was the preferred therapeutic decision for
successful completion of the oncological treatment. After a week, the electrocardiogram showed
sinus rhythm. The patient also completed left-sided radiotherapy with total tumor dose of
41,25Gy, and six months after has stabile cardiac performances and normal sinus rhythm.
CONCLUSION: CRT-CVT is the second leading cause of death in breast cancer patients.
Management of the adverse effects is challenging and complex due to the imperative of
completing the cancer therapy and frequent drug-drug interactions. Early detection,
multidisciplinary approach and close monitoring are the cornerstone for overall good outcome in
these patients.
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