22719160 Visualization

In January Date 2009 Date , a 57 Age - year Age - old Age woman Sex emergently presented Clinical_event with acute Detailed_description shortness Sign_symptom of Sign_symptom breath Sign_symptom .
She had a 1 Duration - month Duration history of progressive Detailed_description shortness Sign_symptom of Sign_symptom breath Sign_symptom and a gradual Lab_value decrease Lab_value in exercise Diagnostic_procedure capacity Diagnostic_procedure secondary to mild Severity dyspnea Sign_symptom .
She reported no additional Sign_symptom symptoms Sign_symptom .
At age Date 40 Date , she had been diagnosed Clinical_event with a stage History IIA, History T1bN1, History left Detailed_description - sided Detailed_description breast Disease_disorder cancer Disease_disorder .
Initial treatment had included a lumpectomy Therapeutic_procedure and axillary Biological_structure node Therapeutic_procedure dissection Therapeutic_procedure .
She subsequently underwent 4 Dosage cycles Dosage of DOX Medication therapy Medication ( 75 Dosage mg/m2 Dosage ), followed by 8 Dosage cycles Dosage of cyclophosphamide Medication , methotrexate Medication , and 5 Medication - fluorouracil Medication .
Multigated Diagnostic_procedure acquisition Diagnostic_procedure scans Diagnostic_procedure before and after chemotherapy Medication showed normal Lab_value cardiac Diagnostic_procedure function Diagnostic_procedure .
After chemotherapy Medication , she underwent left Biological_structure whole Biological_structure - breast Biological_structure radiation Therapeutic_procedure with an axillary Detailed_description boost Detailed_description .
Because the tumor Sign_symptom had been estrogen Detailed_description receptor Detailed_description - positive Detailed_description , her subsequent medical regimen consisted only of anti Medication - estrogen Medication therapy Medication .
She took tamoxifen Medication for 5 Duration years Duration , and, ever since, the aromatase inhibitor letrozole Medication .
In the 17 Duration years Duration after Duration chemotherapy, she had been active Sign_symptom and in relatively Lab_value good Lab_value health Diagnostic_procedure .
In addition to her other symptoms, she now presented with tachycardia Sign_symptom , tachypnea Sign_symptom , and hypertension Sign_symptom .
She had marked jugular Biological_structure venous Biological_structure distention Sign_symptom , an S3 Sign_symptom , pulmonary Sign_symptom rales Sign_symptom , and trace Severity peripheral Detailed_description edema Sign_symptom .
Initial laboratory Diagnostic_procedure values Diagnostic_procedure were within Lab_value normal Lab_value limits Lab_value except for an elevated Lab_value level of N Diagnostic_procedure - terminal Diagnostic_procedure pro Diagnostic_procedure - brain Diagnostic_procedure natriuretic Diagnostic_procedure peptide Diagnostic_procedure ( >2,000 Lab_value pg/mL Lab_value ).
Results of investigation into the new-onset cardiomyopathy Disease_disorder included normal Lab_value cardiac Diagnostic_procedure enzyme Diagnostic_procedure levels, an electrocardiogram Diagnostic_procedure ( ECG Diagnostic_procedure ) that revealed no ischemic Sign_symptom changes Sign_symptom , and a coronary Biological_structure angiogram Diagnostic_procedure of normal Lab_value appearance.
The ECG Diagnostic_procedure showed sinus Detailed_description tachycardia Sign_symptom with frequent Frequency premature Sign_symptom ventricular Sign_symptom complexes Sign_symptom , left Sign_symptom - axis Sign_symptom deviation Sign_symptom , left Biological_structure atrial Biological_structure enlargement Sign_symptom , and low Detailed_description - voltage Detailed_description QRS Sign_symptom complexes Sign_symptom with nonspecific Detailed_description ST Sign_symptom changes Sign_symptom (Fig.1).
A 2 Detailed_description - dimensional Detailed_description echocardiogram Diagnostic_procedure revealed a left Diagnostic_procedure ventricular Diagnostic_procedure ejection Diagnostic_procedure fraction Diagnostic_procedure ( LVEF Diagnostic_procedure ) of 0.20 Lab_value , severe Severity diffuse Detailed_description left Biological_structure ventricular Biological_structure ( LV Biological_structure ) hypokinesis Sign_symptom , and a mildly Severity dilated Sign_symptom left Biological_structure atrium Biological_structure .
To better define the cause of the LV systolic dysfunction, cardiovascular Diagnostic_procedure magnetic Diagnostic_procedure resonance Diagnostic_procedure ( CMR Diagnostic_procedure ) was performed.
It confirmed the LVEF Diagnostic_procedure of 0.20 Lab_value .
The T2 Diagnostic_procedure - weighted Diagnostic_procedure sequence Diagnostic_procedure showed slow Lab_value flow Diagnostic_procedure secondary to LV Biological_structure dysfunction Disease_disorder , and no myocardial Biological_structure edema Sign_symptom (Fig.2A).
Late Detailed_description gadolinium Diagnostic_procedure enhancement Diagnostic_procedure disclosed diffuse Detailed_description myocardial Biological_structure thinning Sign_symptom and no scarring Sign_symptom (Fig.2B).
The patient was treated Therapeutic_procedure medically Therapeutic_procedure .
Her symptoms Sign_symptom progressively improved Lab_value during therapy Therapeutic_procedure , which consisted of a β Medication - blocker Medication , an angiotensin Medication - converting Medication enzyme Medication inhibitor Medication , digoxin Medication , and a diuretic Medication .
The therapy Coreference was slowly tapered Lab_value , and her LVEF Diagnostic_procedure increased Lab_value from 0.20 Lab_value to 0.55 Lab_value during an 8 Duration - month Duration period Duration .
All medications Medication except for low Dosage - dose Dosage metoprolol Medication were discontinued Lab_value after Date 1 Date year Date , and she remained asymptomatic Sign_symptom .