A Case of Docetaxel-Induced Left Ventricular Outflow Tract Obstruction

Abstract

Docetaxel, a taxoid chemotherapy agent, may induce fluid retention. We present a case of metastatic breast cancer in which high output caused by docetaxel-induced fluid retention resulted in heart failure due to left ventricular outflow tract (LVOT) obstruction. A 58-year-old woman presented with exertional dyspnea and anasarca. The jugular venous pressure was elevated, and the carotid pulse was pulsus bisferiens with a spike-and-dome configuration. On auscultation, a mid-late systolic murmur that did not radiate to the neck but increased with the Valsalva maneuver was noted. Echocardiography revealed a left ventricular ejection fraction of 63% with systolic anterior motion (SAM) of the mitral valve, resulting in LVOT obstruction with a resting pressure gradient of 64 mmHg and moderate to severe mitral regurgitation. Treatment with carvedilol, trichlormethiazide, and an increased dose of furosemide gradually improved her symptoms, physical findings, and echocardiographic abnormalities. This case highlights the importance of recognizing high-output heart failure along with LVOT obstruction in patients scheduled to receive docetaxel.

Keywords: docetaxel; fluid retention; heart failure; high-output; left ventricular outflow tract.

Figure 1. Echocardiography

Apical three-chamber views at end-diastole (A) and end-systole (B) show SAM of the mitral valve (arrow). Color Doppler images of an apical three-chamber view (C) and four-chamber view (D) show an LVOT obstruction, along with mitral regurgitation (arrowheads), with a peak flow velocity of 4.0 m/s (E) Ao: aorta, LA: left atrium, LV: left ventricle