Bradycardia as a rare symptom of cisplatin cardiotoxicity: A case report

Abstract

Abstract. Cisplatin (DDP) is one of the most frequently used chemotherapeutic agents, and has a characteristic toxicity profile. For DDP, complications affecting the cardiovascular system, which are typical for certain other agents, are rare; however, their occurrence may lead to life-threatening conditions. To the best of our knowledge, there are few reported cases of DDP-induced bradycardia in the relevant medical literature. The current report presents the case of a 58-year-old patient diagnosed with metastatic neuroendocrine carcinoma with a primary lesion in the posterior mediastinum, who was treated with DDP and etoposide chemotherapy. Following the initial chemotherapy cycle, the patient experienced severe symptomatic bradycardia (a drop in heart rate to 40 bpm), with the corrected QT interval prolonged to 424 msec. The patient's condition required close monitoring and treatment. Similar symptoms occurred following each of the three cycles of chemotherapy. Imaging studies performed following the third treatment cycle revealed disease progression, and the patient was referred for palliative care. Reports have indicated that damage to the cardiovascular system, including cardiac ischemia, diastolic disturbances, hypertension and microalbuminuria, may be associated with DDP-based therapy. However, the mechanism of DDP-associated cardiac toxicity remains to be elucidated. It may be induced by factors including direct toxicity, ion imbalance, heart infiltration and, in the case of neuroendocrine tumors, the influence of tumor excretions.

The perfusion of cisplatin and cisplatin structural analogues through the isolated rat heart: The effects on coronary flow and cardiodynamic parameters

“…Cisplatin-induced bradycardia usually occurs at the very beginning of cisplatin chemotherapy (Altundağ et al 2001;Dieckmann et al 2011;Kounis et al 2016;Kucharz et al 2016). In our experiment, we found similar trend for HR.…”

Cell death mechanisms of the anti-cancer drug etoposide on human cardiomyocytes isolated from pluripotent stem cells

“…It has been in clinical use for more than two decades; however, clinical application of ETP are limited due to its side effects on organs like kidney and heart. Although ETP-induced arrhythmia are very rare (Kridis et al 2013 ), however, it has been reported to induce atrial arrhythmia and infarction especially when combined with cytotoxic drug like cisplatin (Kucharz et al 2016 ; Petrella et al 1989 ). In addition, several case studies also reported myocardial infarction and vasospastic angina in ETP-treated patients (Schwarzer et al 1991 ; Yano and Shimada 1996 ).…”

The Platinum(II) Complexes Induced Oxidative Stress of Isolated Rat Heart

“…Cardiotoxicity may be an early or late complication after treatment with cisplatin. Acute manifestations are accompanied with electrocardiographic changes and arrhythmias, while late complications are primarily associated with the development of cardiomiopathy and congestive heart failure (12)(13)(14). Experimental evidence supports the hypothesis that cisplatin and its analogues promote cardiotoxicity through the formation of reactive oxygen species (ROS), such as superoxide anion radical (O 2 -.…”