It was bound to happen eventually. You are so focused on taking care of patients with breast cancer and the potential for treatment-related side effects, when you hear a Code Blue over the hospital PA system and it is your breast cancer patient! The one with Stage I disease, the one who had no previous cardiac comorbidities, and the one who received round one of chemotherapy with an undiagnosed C. difficile infection.
My patient is a lovely 54-year-old woman who had mastectomy in November 2014, and now remains in the critical care unit on a ventilator after coding three times within 30 minutes. We were sure she would not survive, but she is gaining each day.
With all the specialists on her case, the one thing that was established is the diagnosis of Takotsubo cardiomyopathy. This type of cardiomyopathy is a non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart, particularly the left ventricle. This weakening can be triggered by emotional stress, such as the death of a loved one, a break-up, or constant anxiety. It is also known as "broken heart syndrome."1,2 Despite the grave initial presentation in some patients, most patients survive the initial acute event with a very low rate of inpatient mortality or complications. Patients should expect a favorable outcome once they recover from the acute stage of the syndrome, and the long-term prognosis is excellent.3
As the nurse navigator and nurse practitioner in breast oncology, I had to step aside and let the code team take over while I stayed with the family to help provide updates and support. The physician team was outstanding in giving the family hope for their loved one. This patient had been through so much emotionally early on with her diagnosis. She has a teenage son she felt she needed to protect and a husband who was struggling with family life during the decision-making process and treatment. We know that stress can cause cardiac-related issues and now we have a clinical name for it.
One thing is for certain, I have learned so much from this patient and her family. It has been a privilege to be a part of her care, despite the unexpected turn of events.
Have you treated cancer patients diagnosed with Takotsubo cardiomyopathy? If so, what was the outcome?
Eshtehardi P, et al. (2009). Transient apical ballooning syndrome--clinical characteristics, ballooning pattern, and long-term follow-up in a Swiss population. Int J Cardiol., 135(3): 370–5.
Male breast cancer accounts for about 1% of all breast cancer cases in the United States, therefore it can be a shocking diagnosis. During my career as a nurse practitioner in the field of breast oncology, I have been involved in the care of only five male breast cancer cases over the last 25 years.
FDA Approves Onivyde for Advanced Pancreatic Cancer Marijke Vroomen Durning, RN, 10/27/2015 3 On October 22, 2015, the US Food and Drug Administration (FDA) approved Onivyde (irinotecan liposome injection, Merrimack Pharmaceuticals, Inc.), in combination with fluorouracil ...