Multiple drugs
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Cardiomyopathy: case report An adult woman developed cardiomyopathy during chemotherapy including dactinomycin, vincristine, doxorubicin, cyclophosphamide and ifosfamide. The woman was hospitalised with imminent cardiogenic shock due to cancer therapy-related cardiotoxicity. Her medical history included nephrectomy for clear cell renal sarcoma of the kidney at the age of 7 months. She had received adjuvant chemotherapy including dactinomycin [actinomycin D], vincristine [vincristine sulfate], doxorubicin [doxorubicin hydrochloride] and cyclophosphamide [dosages and routes not stated]. After 1 year, she exhibited bone metastases in left scapula and right maxillary sinus, for which she had received 6 months chemotherapy including ifosfamide and doxorubicin (cumulative dose 200mg) [exact dosages and routes not stated] and fractionated radiotherapy. At the age of 9 years, she underwent a right thyroid lobectomy for papillary carcinoma. She was healthy for 11 years. At the age of 20 years, she was admitted with right arm weakness and sudden motor aphasia. Subsequent CT angiography demonstrated an ischemic stroke due to middle cerebral artery M1 segment occlusion. Further examination revealed a heterozygous factor V Leiden mutation. Additionally, she exhibited a massive enlarged left atrium (6cm) with thrombotic material in cavity despite sinus rhythm. She was diagnosed with a mitral valve regurgitation grade 2 with a global normal left ventricular function. She started receiving warfarin for atrial thrombosis. Over the next 4 years, she was followedup annually. At the age of 24 years, she was hospitalised with a cardiac decompensation due to reduced left ventricular ejection fraction. A MRI showed myocardial fibrosis, which was confirmed with endomyocardial biopsy and myocarditis was excluded. The isolated massive enlarged left atrium and myocardial fibrosis were considered to be due to cardiomyopathy [durations of treatments to reactions onset not stated]. Following modification of unspecified heart failure medications and and clinical recompensation, the woman was discharged from the hospital. Thereafter, her left ventricular function gradually worsened and she was admitted with cardiogenic shock at the age of 29 years. Immediately after her admission, she had cardiac arrest. She was resuscitated for 2 minutes until return of spontaneous circulation. Subsequently, her condition improved and she was in stable condition. She received treatment with dobutamine and norepinephrine. Subsequent right heart catheterization confirmed a severe cardiogenic shock with a cardiac index of 1.7 L/min/m2. She underwent percutaneous Impella CP implantation. She continued to receive dobutamine for right ventricular support. Increased lactate level was reversed with dobutamine and Impella implantation. She received intermittent treatment with amiodarone for atrial fibrillation. Despite Impella support, she had persistent atrial fibrillation and right ventricular deterioration due to pulmonary hypertension, which led to recurrent dec
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