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Case Reports
. 2023 Dec 26;15(12):e51122.
doi: 10.7759/cureus.51122. eCollection 2023 Dec.

Carmustine-Induced Takotsubo Cardiomyopathy

Muhammad Z Khan  1 , Muhammad Waqas  2 , Hadia Shah  3 , Sona Franklin  4 , Ayesha Jamil  5
Affiliations
Case Reports

Carmustine-Induced Takotsubo Cardiomyopathy

Muhammad Z Khan et al. Cureus. .

Abstract

Carmustine is an intravenous alkylating agent that inhibits DNA synthesis and protein synthesis by forming cross-links in DNA and RNA and ultimately causing cell death. We report a rare case of Takotsubo cardiomyopathy that is thought to be related to carmustine, where the patient presented with chest pain, and ST depression within 12 hours of carmustine therapy. Workup, including echocardiography, showed global hypokinesis of the left ventricle with regional variations; mid and apical anterior septum and apex were akinetic with left ventricular ejection fraction (EF) of 30%. Cardiac catheterization showed nonobstructive coronary artery disease. The patient was treated with a beta-blocker, angiotensin receptor-neprilysin inhibitor (ARNi), and aldosterone receptor antagonists. Two days later, he had a repeat echocardiogram that showed improved EF. After stem cell infusion, his course was complicated with atrial fibrillation with rapid ventricular response and septic shock. Unfortunately, he suffered a cardiac arrest and expired. Carmustine-related cardiomyopathy seems to be very rare, and, to our knowledge, this is the first case report.

Keywords: carmustine; drug-induced takosubo cardiomyopathy; heart failure; stress induced cardiomyopathy; takotsubo cardiomyopathy (ttc).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Cardiac magnetic resonance imaging, demonstrating normal systolic function
RA, right atrium; LA, left atrium; LV, left ventricle; RV, right ventricle
Figure 2
Figure 2. Echocardiogram of the patient showing akinetic apex and global hypokinesis of the left ventricle with regional variations
RA, right atrium; LA, left atrium; LV, left ventricle; RV, right ventricle
Figure 3
Figure 3. Echocardiogram of the patient showing improved regional wall motions
RA, right atrium; LA, left atrium; LV, left ventricle; RV, right ventricle
See this image and copyright information in PMC

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