[Hypercirculatory heart failure in a patient with plasmacytic leukemia]

Area of Science:

• Cardiology
• Hematology
• Oncology

Background:

• High cardiac output failure (HCOF) is a known complication of various conditions, including thiamine deficiency, hyperthyroidism, severe anemia, Paget's disease, and arteriovenous fistulae.
• HCOF is infrequently reported in patients with multiple myeloma.

Observation:

• A 31-year-old male presented with fatigue, dyspnea, and subfebrilities, exhibiting cardiomegaly, pulmonary edema, and a hyperkinetic heart on echocardiography.
• Diagnostic workup revealed plasmacytic leukemia (a form of multiple myeloma) with monoclonal gammopathy and osteolytic lesions.
• The patient's cardiac status initially deteriorated, with elevated right atrial, pulmonary artery, and pulmonary artery wedge pressures, and a cardiac output of 20.0 L/min.

Findings:

• Treatment with chemotherapy (vincristine, adriamycine, dexamethasone) and heart failure management led to gradual improvement.
• The patient achieved complete remission of multiple myeloma and normalization of cardiac parameters.
• The study highlights HCOF as a potential, albeit rare, presentation of multiple myeloma.

Implications:

• Early consideration of HCOF is crucial in multiple myeloma patients presenting with heart failure and preserved left ventricular function.
• Potential causes of heart failure in multiple myeloma include cardiac amyloidosis, hyperviscosity syndrome, coronary artery disease, and anthracycline toxicity.
• This case underscores the importance of a multidisciplinary approach in managing complex cases of multiple myeloma with cardiac involvement.