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Mavacamten for Obstructive HCM in Malignancy With Life-Threatening Symptoms
Maria Clara Llamedo1, Alexandra Pons Riverola2, Vijay Maharajan3
1Cardio-Oncology Centre of Excellence, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: https://twitter.com/LlamedoClara.
Background:
A 79-year-old woman admitted to critical care with obstructive hypertrophic cardiomyopathy and metastatic pancreatic neuroendocrine tumor presented with recurrent pulmonary edema and hemodynamic compromise from dynamic left ventricular outflow tract obstruction.
Case Summary:
Mavacamten was initiated, leading to rapid symptomatic improvement. However, during the course of treatment, the patient developed marked liver enzyme elevation, raising concern for drug-induced liver injury or an alternate oncological diagnosis.
Discussion:
Multidisciplinary discussion was essential for reaching the final diagnosis of biliary obstruction and restarting mavacamten, breaking the vicious circle of recurrent presyncope and pulmonary edema secondary to dynamic left ventricular outflow tract obstruction.
Take-Home Message:
Multidisciplinary decision-making is paramount when considering novel therapies in complex cardio-oncology patients.
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