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Acute heart failure: case report A 43-year-old woman with breast cancer developed acute heart failure after receiving an epirubicin-containing regimen followed by trastuzumab [routes not stated]. Following diagnosis of left breast cancer and subsequent mastectomy, the woman underwent radiochemotherapy. Between March and June, she received five cycles of epirubicin 150mg (total dose 750mg), cyclophosphamide and fluorouracil. At this point her left ventricular ejection fraction (LVEF) decreased from 67% to 54%. She received trastuzumab between August and September, initially 400mg and then a second dose of 300mg. In early October she developed exertional dyspnoea and orthopnoea. Acute heart failure was diagnosed (LVEF 18%) and she was hospitalised mid-October. Despite treatment with a diuretic and intravenous dopamine, the reduced LVEF and sinus tachycardia persisted. The woman’s clinical condition deteriorated on hospital day 20. Thereafter, her condition gradually improved with an increased diuretic dose and initiation of oral therapy with spironolactone, imidapril, carvedilol and digoxin. Her LVEF had increased to 34% by day 27 and treatment was gradually transitioned to oral furosemide only. She was discharged on day 61. Follow-up investigations on day 76 showed a LVEF of 51%. Yamada T, et al. A case of postoperative breast cancer presented acute heart failure after trastuzumab treatment. Therapeutic Research 32: 899-903, No. 7, 20 Jul 2011 803062617 [Japanese; summarised from a translation] - Japan

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Reactions 12 Nov 2011 No. 1377