Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
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Case Report

Volume 10, Number 4, August 2019, pages 230-235

Trastuzumab-Induced Cardiomyopathy and Intermittent Left Bundle Branch Block

Figures

Figure 1.
Figure 1. Presenting ECG to cardiology clinic with NSR and newly recognized LBBB. ECG: electrocardiogram; NSR: normal sinus rhythm; LBBB: left bundle branch block.
Figure 2.
Figure 2. Prior ECG with NSR and normal conduction. ECG: electrocardiogram; NSR: normal sinus rhythm.
Figure 3.
Figure 3. Preoperative ECG with recurrent LBBB. ECG: electrocardiogram; LBBB: left bundle branch block.
Figure 4.
Figure 4. ECG obtained upon patient’s return to cardiology clinic for preoperative risk assessment. This tracing shows the absence of LBBB and new T-wave inversions in multiple leads (arrows). ECG: electrocardiogram; LBBB: left bundle branch block.
Figure 5.
Figure 5. Representative ECG tracings during exercise stress revealing the development of intermittent LBBB (arrows). ECG: electrocardiogram; LBBB: left bundle branch block.
Figure 6.
Figure 6. Example images from nuclear perfusion testing suggesting anteroseptal ischemia (arrows). The top row of images are stress images and the bottom are rest images (displayed left to right: short axis apex to base (a-c), horizontal long axis (d) and vertical long axis (e)).
Figure 7.
Figure 7. Representative images from coronary angiography revealing no significant CAD: (a) left coronary system; (b) right coronary system. CAD: coronary artery disease.

Table

Table 1. Non-Myopathic Cardiac Complications Associated With Trastuzumab [6, 13-17]
 
ComplicationsStudySymptomsFurther testing and resultsCardiomyopathy present
LBBB: left bundle branch block; RBBB: right bundle branch block; LV: left ventricular; NSVT: non-sustained ventricular tachycardia.
Asymptomatic new LBBBPiotrowski et al [6]No symptomsNoNo
New RBBBPiotrowski et al [6]No SymptomsNoNo
T-wave inversions in anterior leadsOlin et al [13]Chest painLeft heart catheterization revealed normal coronaries.No
Sinus node dysfunctionOlin et al [13]SyncopeNoNo
Symptomatic new LBBBTwo studies (Tu et al [14] and Ribiero et al [15])Chest pain and shortness of breathLeft heart catheterization revealed normal coronaries.Yes
Ventricular tachycardiaOliveira et al [16]Sudden deathAutopsy showed LV hypertrophy, myocardial lymphocytic infiltrate, pulmonary congestion.Yes
Non-sustained ventricular tachycardiaFerguson et al [17]palpitations and near-syncopeHolter revealed NSVTNo