Mase Taiga, Honda Sakiko, Yamano Michiyo, Kawasaki Tatsuya
Department of Cardiology, Matsushita Memorial Hospital, Moriguchi, JPN.
Cureus. 2023 Aug 16;15(8):e43598. doi: 10.7759/cureus.43598. eCollection 2023 Aug.
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.
多西他赛是一种紫杉类化疗药物，可能会导致液体潴留。我们报告一例转移性乳腺癌患者，多西他赛诱导的液体潴留导致高输出量，进而因左心室流出道（LVOT）梗阻引发心力衰竭。一名58岁女性因劳力性呼吸困难和全身性水肿就诊。颈静脉压升高，颈动脉搏动呈双峰脉，呈尖峰-圆顶形态。听诊时，可闻及中晚期收缩期杂音，未向颈部传导，但在瓦尔萨尔瓦动作时增强。超声心动图显示左心室射血分数为63%，二尖瓣有收缩期前向运动（SAM），导致LVOT梗阻，静息压力阶差为64 mmHg，伴有中度至重度二尖瓣反流。使用卡维地洛、三氯噻嗪和增加剂量的呋塞米治疗后，她的症状、体格检查结果和超声心动图异常逐渐改善。该病例强调了在计划接受多西他赛治疗的患者中识别高输出量心力衰竭伴LVOT梗阻的重要性。
