Ново дијагостицирана атријална фибрилација кај пациентка со активен карцином на дојка: тераписки предизвик - приказ на случај

Abstract

Breast cancer is the most common malignant disease in females. The specific cancer treatment protocol involves drugs with known cardiovascular toxicity. Patients with significant risk of cancer therapy-related cardiovascular toxicity (CRT-CVT) should be reported for cardiology referral. CASE REPORT: Seventy-year-old, obese patient with a previous history of hypertension and low normal left ventricular ejection fraction (LVEF) was diagnosed with breast cancer and scheduled for baseline assessment before initiating cardiotoxic cancer treatment protocol. Regular monitoring for an already high-risk patient for CRT-CVT was not enough for developing of first diagnosed, paroxysmal, asymptomatic atrial fibrilation after completing the 4 th cycle of anthracyclines and total cumulative dose of 208.3mg/m2. Transthoracic echocardiography did not reveal significant changes in LVEF and global longitudinal strain, so cancer therapy-related cardiac dysfunction was not the related diagnosis. Laboratory measurements of cardiac biomarkers did not confirm subclinical cardiac injury. Besides ACEinhibitors already prescribed for hypertension, drugs for rate control and anticoagulation therapy with both low-molecular-weight heparin and NOAC was the preferred therapeutic decision for successful completion of the oncological treatment. After a week, the electrocardiogram showed sinus rhythm. The patient also completed left-sided radiotherapy with total tumor dose of 41,25Gy, and six months after has stabile cardiac performances and normal sinus rhythm. CONCLUSION: CRT-CVT is the second leading cause of death in breast cancer patients. Management of the adverse effects is challenging and complex due to the imperative of completing the cancer therapy and frequent drug-drug interactions. Early detection, multidisciplinary approach and close monitoring are the cornerstone for overall good outcome in these patients.