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Case Reports
. 2020 Jul 28;13(7):e236009.
doi: 10.1136/bcr-2020-236009.

Intermittent left bundle branch block and acute heart failure in trastuzumab-induced cardiotoxicity

Ravi Masson  1 , Hooman Bakhshi  2 , Tariq M Haddad  2   3
Affiliations
Case Reports

Intermittent left bundle branch block and acute heart failure in trastuzumab-induced cardiotoxicity

Ravi Masson et al. BMJ Case Rep. .

Abstract

A 70-year-old woman with HER2+/ER+ breast cancer on adjuvant trastuzumab therapy without a history of cardiovascular disease presented with respiratory failure from influenza and was found to have intermittent left bundle branch block (LBBB) with new onset systolic heart failure. Her course was complicated by polymorphic ventricular tachycardia and recurrent chest pain. Significant investigations included a normal cardiac MRI and cardiac catheterisation with unobstructed coronaries. It was determined that the aetiology of her heart failure was trastuzumab-induced cardiotoxicity after comprehensive workup. This case highlights an uncommon presentation of LBBB and the steps taken to diagnose a rare cardiomyopathy.

Keywords: breast cancer; cancer - see oncology; chemotherapy; heart failure; unwanted effects / adverse reactions.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
ECG on admission showing sinus tachycardia with left bundle branch block.
Figure 2
Figure 2
Post cardiac arrest ECG showing sinus bradycardia with broad and deep T-wave inversions.
Figure 3
Figure 3
ECG obtained during acute chest pain episode showing normal sinus rhythm with recurrence of left bundle branch block.
Figure 4
Figure 4
Telemetry strip indicating axis change from left bundle branch block to normal morphology without change in heart rate (HR).
See this image and copyright information in PMC

References

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