title: Heart failure secondary to carfilzomib-induced heart block in multiple myeloma patients.
abstract: Carfilzomib is a proteasome inhibitor and immunomodulator used to treat patients with multiple myeloma who have disease progression refractory to bortezomib. The difference in agents is that carfilzomib is an irreversible inhibitor of 20 s proteasome. The most common side effects of carfilzomib are fatigue, nausea, diarrhea, anemia, thrombocytopenia, dyspnea, and pyrexia. Less frequent side effects include cardiac manifestations for which we will explore with more detail. In this case report, we describe a 70-year-old female with multiple myeloma presenting to the emergency department with complaint of dyspnea. Patient was discovered to be in heart failure with atrioventricular block necessitating placement of a pacemaker.
authors.affiliation: Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, NJ, USA.
authors.forename: Harisios
authors.initials: H
authors.lastname: Tjionas
authors.affiliation: Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, NJ, USA.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Gupta
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000601:surgery; D001806:Blood Urea Nitrogen; D001919:Bradycardia / Q000209:etiology; D058409:Cardiac Resynchronization Therapy Devices; D066126:Cardiotoxicity / Q000150:complications; D003404:Creatinine / Q000097:blood; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000139:chemically induced / Q000150:complications*; D006333:Heart Failure / Q000097:blood / Q000209:etiology*; D006801:Humans; D009101:Multiple Myeloma / Q000188:drug therapy*; D009842:Oligopeptides / Q000009:adverse effects* / Q000627:therapeutic use; D061988:Proteasome Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000175:diagnosis; D013902:Radiography, Thoracic; D018570:Risk Assessment; D065467:Transcatheter Aortic Valve Replacement; D014692:Ventilation-Perfusion Ratio; D028761:Withholding Treatment
chemical_list: D000970:Antineoplastic Agents; D009842:Oligopeptides; D061988:Proteasome Inhibitors; C524865:carfilzomib; D003404:Creatinine
keywords: Carfilzomib; emergency department; heart block; heart failure; oncologic emergency