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Case Reports
. 2012 Jan;5(1):125-33.
doi: 10.1159/000337576. Epub 2012 Mar 17.

Trastuzumab-induced myocardiotoxicity mimicking acute coronary syndrome

K B Ribeiro  1 , C H Miranda, J M Andrade, L G Galli, D G Tiezzi, H F Oliveira, F E Zola, G Volpe, A Pazin-Filho, F M Peria
Affiliations
Case Reports

Trastuzumab-induced myocardiotoxicity mimicking acute coronary syndrome

K B Ribeiro et al. Case Rep Oncol. 2012 Jan.

Abstract

Trastuzumab is an important biological agent in the treatment of HER2-positive breast cancer, with effects on response rates, progression-free survival, overall survival and quality of life. Although this drug is well tolerated in terms of adverse effects, trastuzumab-associated myocardiotoxicity has been described to have an incidence of 0.6-4.5% and in rare cases, the drug can trigger severe congestive heart failure with progression to death or even mimic acute coronary syndrome with complete left bundle branch blockade. In this paper is reported a case of trastuzumab-associated myocardiotoxicity manifesting as acute coronary syndrome in a 69-year-old female. The patient is currently undergoing a conservative clinical treatment that restricts overexertion.The majority of clinical studies report trastuzumab-induced cardiotoxicity as a rare event, and, when present, characterized by mild to moderate clinical signs, the ease of reversibility with pharmacological measures and the temporary discontinuation of the medication. Conversely, it is vital for the oncologist/cardiologist to consider the possibility that trastuzumab-induced cardiotoxicity may manifest itself as a severe clinical case, mimicking acute coronary syndrome, justifying careful risk stratification and adequate cardiac monitoring, especially in high-risk patients.

Keywords: Acute coronary syndrome; Breast cancer; Myocardiotoxicity; Trastuzumab.

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Figures

Fig. 1
Fig. 1
Chest radiograph with cardiomegaly and pulmonary congestion. ECG with sinus tachycardia, advanced LBBB and ST-segment elevation on the anterior wall of the myocardium (July 13, 2010).
Fig. 2
Fig. 2
Chest radiograph showing cardiomegaly without pulmonary congestion. ECG with sinus rhythm, HR of approximately 100 bpm and a lesion on the anterior wall (July 16, 2010).
Fig. 3
Fig. 3
Temporal correlation of LVEF.
See this image and copyright information in PMC

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