DOI: 10.12890/2026_006046

One dose, one wall: isolated septal hypokinesia triggered by first doxorubicin exposure

Authors

  • Antonio Al Hazzouri Department of Internal Medicine, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
  • Omar Msadi Department of Internal Medicine, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
  • Maria Azar Department of Internal Medicine, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
  • Leen Jurdi Department of Internal Medicine, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
  • Samer Nasr Division of Cardiology, Mount Lebanon Hospital University Medical Center, University of Balamand, Beirut, Lebanon

antonio.hazzouri@std.balamand.edu.lb

Keywords

Cardiotoxicity, cardiomyopathy, hypokinesia, doxorubicin, anthracycline, echocardiography

Abstract

Cardiotoxicity or cardiomyopathy is a common side effect of the use of anthracyclines for the treatment of cancer patients. Anthracyclines produce their harmful effect on the heart after several cumulative doses; however, it is rare to find the development of cardiotoxicity after only the first dose of chemotherapy. We report a case of a young male known to have acute lymphoblastic leukaemia (ALL) who developed cardiotoxicity following the first dose of doxorubicin. The patient presented with dyspnoea, orthopnoea and chest pain, and bilateral limb oedema. He had a significant hypoxaemia requiring oxygen, raised jugular venous pressure, bilateral rales and a third heart sound on examination. A transthoracic echocardiography was performed and showed a low left ventricular ejection fraction of 40%, marked left ventricular dilation and septal hypokinesia, with no global hypokinesia and normal lateral wall motion, confirming our diagnosis of anthracycline-induced cardiotoxicity following the first dose. This report discusses a rare finding of cardiotoxicity following the first dose of doxorubicin in a young male patient with ALL. Doxorubicin is known to cause dilated cardiomyopathy and global hypokinesia; nonetheless, our patient had an isolated septal hypokinesia with normal lateral wall motion. This case should raise awareness about early prevention of cardiotoxicity as it can occur early in the treatment, rather than waiting for late onset of toxicity.

View the entire article

Downloads

References

  1. Zarifa A, Albittar A, Kim PY, Hassan S, Palaskas N, Iliescu C, et al. Cardiac toxicities of anticancer treatments: chemotherapy, targeted therapy and immunotherapy. Curr Opin Cardiol 2019;34:441–450. doi:10.1097/HCO.0000000000000641
  2. Abdul-Rahman T, Dunham A, Huang H, Bukhari SMA, Mehta A, Awuah WA, et al. American College of Cardiology Medical Student Member Community (ACC:MSMC) – Cardiovascular Research Initiative (CVRI) group. Chemotherapy induced cardiotoxicity: a state of the art review on general mechanisms, prevention, treatment and recent advances in novel therapeutics. Curr Probl Cardiol 2023;48:101591. doi:10.1016/j.cpcardiol.2023.101591
  3. Bovelli D, Plataniotis G, Roila, F. ESMO Guidelines Working Group. Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO Clinical Practice Guidelines. Ann Oncol 2010;21:v277–v282. doi:10.1093/annonc/mdq200
  4. Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced cardiotoxicity. Maedica (Bucur) 2013;8:59–67.
  5. Yang SC, Chuang MH, Li DK. The development of congestive heart failure and ventricular tachycardia after first exposure to idarubicin in a patient with acute myeloid leukaemia. Br J Clin Pharmacol 2010;69:209–211. doi:10.1111/j.1365-2125.2009.03563.x
  6. Ahmed Z, Davaro E, Batanian J, Verma N. First-dose idarubicin cardiomyopathy: a case of new heart failure after induction chemotherapy for acute myeloid leukaemia. BMJ Case Rep 2019;12:e228149. doi:10.1136/bcr-2018-228149
  7. Hasnie AA, Neace Z, Ellison K, Hesselson AB, Ayoub K, Al-Yafi MA. Two cardiotoxicities from one dose of chemotherapy? J Am Coll Cardiol 2024;83:4339. doi:10.1016/S0735-1097(24)06329-0
  8. Meter M, Gavran I, Bajo D, Duplancic D. An unusual case of acute myopericarditis after the first dose of capecitabine: need for new cardioprotective strategies and risk stratification. Int J Clin Pharmacol Ther 2021;59:775–779. doi:10.5414/CP204006
  9. Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, et al. ESC Scientific Document Group. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022;43:4229–4361. doi:10.1093/eurheartj/ehac244
  10. Daniele AJ, Gregorietti V, Costa D, López-Fernández T. Use of EMPAgliflozin in the Prevention of CARDiotoxicity: the EMPACARD - PILOT Trial. Cardiooncology 2024;10:58. doi:10.1186/s40959-024-00260-y
  11. Mohamed AL, El-Abd AA, Mohamed HG, Noufal AM, Hennawy BS. Role of statin therapy in prevention of anthracycline-induced cardiotoxicity: a three dimentional echocardiography study. Curr Probl Cardiol 2024;49:102130. doi:10.1016/j.cpcardiol.2023.102130
  12. Ciburiene E, Aidietiene S, Scerbickaite G, Sadauskiene E, Sudaviciene D, Baltruskeviciene E, et al. For the prevention of anthracycline-induced cardiotoxicity in female patients with primarily breast cancer: a prospective, randomized, open-label clinical trial. Medicina (Kaunas) 2023;59:2140. doi:10.3390/medicina59122140

Published

2026-01-13

Issue

Vol. 13 No. 2 (2026)

Categories

How to Cite

1.
Al Hazzouri A, Msadi O, Azar M, Jurdi L, Nasr S. One dose, one wall: isolated septal hypokinesia triggered by first doxorubicin exposure. EJCRIM [Internet]. 2026 Jan. 13 [cited 2026 Nov. 3];13(2). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6046

Most read articles by the same author(s)