Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
Department of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia, USA.
BMJ Case Rep. 2020 Jul 28;13(7):e236009. doi: 10.1136/bcr-2020-236009.
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.
一位 70 岁的 HER2+/ER+乳腺癌女性患者正在接受曲妥珠单抗辅助治疗，既往无心血管疾病史，因流感导致呼吸衰竭，检查发现间歇性左束支传导阻滞（LBBB），并新发收缩性心力衰竭。其病程还并发多形性室性心动过速和反复胸痛。重要的检查包括心脏 MRI 和心导管检查，均显示冠状动脉无阻塞。经过全面检查，确定其心力衰竭的病因是曲妥珠单抗引起的心脏毒性。该病例突出了 LBBB 的一种不常见表现，以及为诊断罕见心肌病而采取的步骤。
