Case Report
Fatal Acute Right Heart Failure in Gastric Cancer Patients Sang-Hoon Seol, Bo-Min Park, Han-Young Jin, Doo-Il Kim Department of Internal Medicine, Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
ABSTRACT Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare condition causing pulmonary artery hypertension and acute right heart failure in patients with cancer. However, chest computer tomography shows negative finding of pulmonary thromboembolism. Serum D-dimer level may be elevated. Echocardiography reveals a dilated right ventricle and feature of pulmonary artery hypertension. Establishing this diagnosis can be very difficult, and most cases are diagnosed during autopsy, although a history of cancer may be a predictor. PTTM should be considered in all patients with apparent pulmonary artery hypertension and elevated D-dimer level, particularly when the patient is known to have an underlying malignancy, especially adenocarcinoma and most of all, the clinical manifestation is very rapidly progressive.
Key words: D-dimer, gastric cancer, right heart failure How to cite this article: Seol S, Park B, Jin H, Kim D. Fatal acute right heart failure in gastric cancer patients. Heart Views 2013;14:179-81. © Gulf Heart Association 2013.
INTRODUCTION
P
ulmonary tumor thrombotic microangiopathy (PTTM) is a rare condition causing pulmonary artery hypertension and acute right heart failure in patients with cancer. It should be suspected in patients with unexplained severe dyspnea, pulmonary artery hypertension, and elevated D-dimer especially in the presence of adenocarcinoma. We are reporting two cases of patients presenting with acute cor pulmonale secondary to gastric cancer, suggesting a PTTM.
CASE REPORTS Case 1
A 46-year-old woman with gastric cancer presented with a 2 week period of progressively worsening shortness of breath. Six months earlier, she had a total gastrectomy. However, the adjuvant chemotherapy was not done because of her refusal. On admission, the physical examination including auscultation was unremarkable. The patient was afebrile with tachycardia of 116/ min, respiratory rate of 28/min, and blood pressure of 100 /60 mmHg. Laboratory findings were remarkable for microcytic anemia and a strong positive D-dimer (11.8 µg/mL, normal
Fatal Acute Right Heart Failure in Gastric Cancer Patients Sang-Hoon Seol, Bo-Min Park, Han-Young Jin, Doo-Il Kim Department of Internal Medicine, Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
ABSTRACT Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare condition causing pulmonary artery hypertension and acute right heart failure in patients with cancer. However, chest computer tomography shows negative finding of pulmonary thromboembolism. Serum D-dimer level may be elevated. Echocardiography reveals a dilated right ventricle and feature of pulmonary artery hypertension. Establishing this diagnosis can be very difficult, and most cases are diagnosed during autopsy, although a history of cancer may be a predictor. PTTM should be considered in all patients with apparent pulmonary artery hypertension and elevated D-dimer level, particularly when the patient is known to have an underlying malignancy, especially adenocarcinoma and most of all, the clinical manifestation is very rapidly progressive.
Key words: D-dimer, gastric cancer, right heart failure How to cite this article: Seol S, Park B, Jin H, Kim D. Fatal acute right heart failure in gastric cancer patients. Heart Views 2013;14:179-81. © Gulf Heart Association 2013.
INTRODUCTION
P
ulmonary tumor thrombotic microangiopathy (PTTM) is a rare condition causing pulmonary artery hypertension and acute right heart failure in patients with cancer. It should be suspected in patients with unexplained severe dyspnea, pulmonary artery hypertension, and elevated D-dimer especially in the presence of adenocarcinoma. We are reporting two cases of patients presenting with acute cor pulmonale secondary to gastric cancer, suggesting a PTTM.
CASE REPORTS Case 1
A 46-year-old woman with gastric cancer presented with a 2 week period of progressively worsening shortness of breath. Six months earlier, she had a total gastrectomy. However, the adjuvant chemotherapy was not done because of her refusal. On admission, the physical examination including auscultation was unremarkable. The patient was afebrile with tachycardia of 116/ min, respiratory rate of 28/min, and blood pressure of 100 /60 mmHg. Laboratory findings were remarkable for microcytic anemia and a strong positive D-dimer (11.8 µg/mL, normal
