In e na ional Jou nal o Medical Science and Clinical Resea ch S udies
ISSN(p in ): 2767-8326, ISSN(online): 2767-8342
Volume 05 Issue 11 No embe 2025
Page No: 1820-1823
DOI: h ps://doi.o g/10.47191/ijmsc s/ 5-i11-03, Impac Fac o : 8.188
1820 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Miguel Ángel Galindo-López
Dila ed Ca diomyopa hy Seconda y o Toxici y om An h acycline
Chemo he apy in a Pa ien wi h a His o y o Acu e Lymphoblas ic Leukemia:
A Case Repo
Miguel Ángel Galindo-López.1, Fe nando O iz-Anaya2
1Physician assigned o he In e nal Medicine Se ice a he Zone 3 Gene al Hospi al, Jesús Ma ía, Aguascalien es, Mexican Social
Secu i y Ins i u e.
2Fou -yea esiden physician in he In e nal Medicine Se ice a he Zone 3 Gene al Hospi al, Jesús Ma ía, Aguascalien es, Mexican
Social Secu i y Ins i u e.
ABSTRACT
ARTICLE DETAILS
Dila ed ca diomyopa hy is de ined by p esence o le en icula o bi en icula dila ion and le
sys olic dys unc ion in absence o hype ension, co ona y disease, o al ula disease ha would
jus i y i . I s causes can be di ided in o wo la ge g oups: hose o gene ic o igin and hose o
nongene ic o igin, which include in ec ious, oxic, and au oimmune disease causes, among o he s.
I s na u al cou se a ies signi ican ly based on he di e en e iologies and i s diagnosis can
in luence he disease's managemen and p ognosis.
Clinical case: 29-yea -old male, wi h a his o y o ha ing su e ed om Acu e Lymphoblas ic
Leukemia a he age o 4 wi h comple e emission o he disease demons a ed a ha ime by bone
ma ow aspi a e and immunopheno ype, ha ing been ea ed wi h an h acyclines. On his
occasion, he a ended due o he p esence o sudden onse dyspnea and hemop ysis, o which in
he i s ins ance, due o he p e iously men ioned his o y, an a emp was made o ule ou
pulmona y h omboembolism wi h ches Angio omog aphy, which was co obo a ed by said
s udy and demons a ing he p esence o wo in aca i a y h ombi. The e o e, a ans ho acic
echoca diog am was pe o med, highligh ing se e e dila ion o he le en icle. Managemen o
hea ailu e was adjus ed based on s uc u al al e a ion demons a ed by echoca diog aphy, wi h
a o able clinical e olu ion.
Conclusions: The na u al his o y o dila ed ca diomyopa hy is no easy o es ablish due o he wide
he e ogenei y o i s e iology and he di e en a es o p og ession depending on i . In some cases,
he e may be unc ional eco e y a e acu e myoca dial damage, o example, in ca diomyopa hy
induced by achyca dia o in ha induced by ca dio oxic d ugs. In o he cases, s abiliza ion o he
disease and sys olic dys unc ion and, in o he s, sudden dea h may be obse ed.
KEYWORDS: Dila ed ca diomyopa hy, an h acyclines, male, dyspnea, hea ailu e.
Published On:
05 No embe 2025
A ailable on:
h ps://ijmsc s.com/
BACKGROUND
Dila ed ca diomyopa hy (DCM) is de ined by he Eu opean
Socie y o Ca diology (ESC) as he p esence o le
en icula o bi en icula dila ion and sys olic dys unc ion
in he absence o abno mal loading condi ions ( al e disease
o hype ension) o co ona y a e y disease su icien o
accoun o global sys olic impai men 1.
In 2016, he ESC p esen ed a e ised de ini ion o DCM,
emphasizing ha his diagnosis encompasses a wide ange o
gene ic and non-gene ic diseases2.
De e mining he incidence and p e alence o DCM has been
challenging due o geog aphic a iabili y, incomple e
pene ance o he disease3, o la e onse o p esen a ion4, as
well as changes in diagnos ic c i e ia5.
DCM is cu en ly conside ed one o he leading causes o
hea ailu e and hea ansplan a ion. The p e alence o
Dila ed Ca diomyopa hy Seconda y o Toxici y om An h acycline Chemo he apy in a Pa ien wi h a His o y o Acu e
Lymphoblas ic Leukemia: A Case Repo
1821 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Miguel Ángel Galindo-López
DCM has adi ionally been es ima ed a 36 pe 100,000
popula ion, wi h an annual incidence o 6 pe 100,0006. The
ESC classi ies he causes o DCM in o wo la ge g oups:
gene ic and non-gene ic causes, al hough he in e ac ion
be ween gene ic p edisposi ion and en i onmen al ac o s is
some imes also ele an . DCM is ecognized as a gene ically
ansmi ed disease in a leas 30–40% o cases. 2 O he
ac o s linked o he pa hogenesis o DCM a e an h acycline
and doxo ubicin de i a i es, whose me aboli es a e belie ed
o ac as oxican s o myocy es, p oducing s uc u al and
unc ional changes in he myoca dium. The common
pa hophysiological basis o he di e en e iologies o DCM
is he loss o myoca dial con ac ile capaci y7.
CLINICAL CASE
This is a 29-yea -old male pa ien , o iginally om and
esiding in Pabellón de A eaga, Aguascalien es. He wo ks as
a wa ehouseman. He epo s his ci il s a us as a common-law
spouse and comple ed high school. His amily his o y only
includes pa e nal gene ics o hype ension. O his signi ican
medical his o y, he epo s ha ing su e ed om acu e
lymphoblas ic leukemia a age 4, unde going ea men wi h
an h acycline-based chemo he apy, wi h comple e emission
o he disease based on bone ma ow aspi a ion and
immunopheno yping du ing ollow-up by he hema ology
depa men .
On his occasion, he p esen ed o he uni wi h p og essi e
dyspnea, which p og essed om se e e o mild exe ion,
las ing app oxima ely 2 mon hs. He epo ed ha he had no
p e iously expe ienced dyspnea, e en pe o ming physical
ac i i y wi hou any di icul y, un il p esen ing wi h di icul y,
e en a wo k, mo ing boxes o packages (clo hing,
elec onics). He also p og essi ely de eloped lowe limb
edema, which he had no p e iously expe ienced in his li e.
This edema wo sened a he end o he day and imp o ed wi h
es . In he las week p io o admission, he also men ioned
ha ing expe ienced hemop ysis, no associa ed wi h e e o
ches pain, wi h an inc ease in he amoun o hemop ysis
du ing ha week, which is why he decided o come o ou uni
o e alua ion.
Upon a i al a he eme gency depa men , his i al signs
we e epo ed wi hin no mal pa ame e s, excep o his
oxygen sa u a ion by pulse oxime y, which was 82%. This
imp o ed wi h he suppo o supplemen al oxygen ia nasal
p ongs a 2 li e s/minu e. No signi ican labo a o y
abno mali ies we e obse ed. Howe e , due o his his o y o
leukemia, he onse o hemop ysis accompanied by dyspnea
and he need o supplemen al oxygen, a ches Angio
omog aphy was o de ed. The e iology o he p esen ing
symp oms was suspec ed o be pulmona y h omboembolism.
The ollowing we e epo ed: pulmona y h omboembolism
o he in e io loba a e y and igh pos e io basal segmen al
a e y, and mul iple in a en icula h ombi. The pa ien
p esen ed wi h pleu al e usion and a elec asis in he igh
egion.
Based on he diagnosis epo ed on he imaging s udy, he
pa ien was aken o he In e nal Medicine loo o u he
ea men . Upon a i al a ou uni , a u he in e iew was
conduc ed, con i ming a clinical his o y consis en wi h hea
ailu e (dyspnea, o hopnea, bendopnea, pa oxysmal
noc u nal dyspnea, elec oca diog am wi h sinus achyca dia,
ches X- ay wi h bila e al pleu al e usion). A signi ican
physical examina ion e ealed c ackles in bo h lung bases and
lowe ex emi y edema (++/++++). He was managed as a
pa ien in his hi d decade o li e wi h hea ailu e and he
p esence o in aca i a y h ombi seen on con as -enhanced
omog aphy, so an assessmen was eques ed by he
ca diology se ice who comple ed i wi h a ans ho acic
echoca diog am whe e he ollowing we e epo ed: 1.
Se e ely dila ed le en icle (indexed TSV 63 ml/m2ASC,
indexed LVSD: 31 mm/m2ASC), no mal en icula
geome y. Indexed le en icula mass: 96 g/m2, RWT: 0.28.
In aca i a y h ombi in he le en icle measu ing 30x16
and 10x13 mm. 2. Res ing segmen al mo ion al e a ions. 3.
LV dias olic dys unc ion ype III/III. Res ic i e pa e n. 4.
No mal-sized igh ca i ies. 5. Sligh ly dila ed le a ium. 6.
Se e e LV sys olic dys unc ion: LVEF 26% 7. RV sys olic
dys unc ion. TAPSE 13 mm, S’: 8.0 cms/s, Tei: 0.82 8. Mild
mi al and pulmona y egu gi a ion. 9. Res ing al ula
lowme y wi hin no mal pa ame e s. No s enosis. 10. Low
p obabili y s udy o pulmona y hype ension. PASP 35
mmHg PMAP 28 mmHg. 11. Ao ic a ch wi h no al e a ions,
no signi ican an e og ade g adien . 12. Pe ica dium wi h
no mal cha ac e is ics. 13. No shun s a he ime o he s udy.
He was also e alua ed by he ca dio ho acic su ge y se ice,
who e e ed him as equi ing e ia y le el ca e o
ca diopulmona y bypass su ge y. The e o e, in ou uni ,
op imal managemen was es ablished o hea ailu e wi h
educed LVEF and an icoagula ion due o he p esence o
in aca i a y h ombi and he es ablished pulmona y
h omboembolism acco ding o Spanish and Ame ican
ca diology guidelines. The pa ien p esen ed adequa e clinical
p og ess, wi hou equi ing e ia y le el ca e upon
e alua ion. The e o e, he pa ien was discha ged om he
se ice wi hou p esen ing new condi ions.
DISCUSSION
A ho ough clinical his o y mus be aken o a i e a a
diagnosis, iden i ying possible ea able o e e sible causes
o he disease. In ou case, he e was a well-es ablished
his o y o myoca dial damage, such as exposu e o
an h acyclines.
The symp oms and signs a e a consequence o le -sided hea
ailu e, gene ally wi h nonspeci ic symp oms such as as henia
and exe ional dyspnea. Depending on he deg ee o inc eased
le a ial p essu e, dyspnea can p esen wi h a ying deg ees
o se e i y8, as was he case in ou pa ien , wi h p og essi e
Dila ed Ca diomyopa hy Seconda y o Toxici y om An h acycline Chemo he apy in a Pa ien wi h a His o y o Acu e
Lymphoblas ic Leukemia: A Case Repo
1822 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Miguel Ángel Galindo-López
dyspnea, e en leading o hemop ysis due o he es ablished
s uc u al damage, combined wi h concomi an pulmona y
h omboembolism and he p esence o in aca i a y h ombi.
I hea ailu e is suspec ed, we should o de a ious
complemen a y es s o con i m ou diagnosis:
1. Ches X- ay: Ca diomegaly is usually obse ed; howe e ,
we seek o ule ou acu e decompensa ion wi h indings such
as signs o pulmona y enous conges ion and, in ad anced
s ages, signs o in e s i ial o al eola pulmona y edema9.
2. Elec oca diog am: This is nonspeci ic; signs o a ial
enla gemen and le en icula hype ophy a e common9.
3. Echoca diog aphy: This is a e y use ul echnique o
con i ming he diagnosis and assessing ca diac unc ion.
DCM is de ined by he p esence o le en icula o
bi en icula sys olic dys unc ion (LVEF less han 45%)
associa ed wi h en icula dila a ion. Ven icula dila a ion is
de ined by an end-dias olic olume o end-dias olic diame e
indexed by body su ace a ea g ea e han he uppe limi o
no mal, de ined as wo s anda d de ia ions abo e he mean.
I is ecommended o use no mal alues calcula ed o he
pa ien 's age and sex as a e e ence9.
4. Ca diac magne ic esonance imaging: Ca diac magne ic
esonance imaging (CMR) is cu en ly conside ed he gold
s anda d o measu ing en icula olumes, mass, and
ejec ion ac ion. In ou ine clinical p ac ice, i s use is
some imes limi ed by i s low a ailabili y and high cos . I is a
ool ha should be conside ed a leas once in e e y pa ien
diagnosed wi h DCM. I can p o ide impo an in o ma ion
ega ding bo h he e iological diagnosis and p ognos ic
s a i ica ion9.
Wi hin ou diagnos ic app oach, he echoca diog am esul s
we e able o be pe o med, mee ing he p e iously desc ibed
cha ac e is ics. This jus i ied adjus ing managemen based on
guidelines o hea ailu e wi h educed LVEF and adequa e
clinical e olu ion. Howe e , as p e iously men ioned in he
li e a u e e iew, i would be impo an o pe o m an
magne ic esonance o he i s ime in ou pa ien and
e alua e he need o gene ic es ing due o i s ela ionship
wi h he desc ibed pa hology.
CONCLUSIONS
The undamen al objec i es o DCM ea men a e he
imp o emen o symp oms and quali y o li e in hese
pa ien s. The e o e, pa ien educa ion on he con ol o hea
ailu e igge s, such as non-adhe ence o ea men o die , is
e y impo an , as well as he ea ly ini ia ion o app op ia e
ea men , bo h wi h pha macological10 and non-
pha macological measu es11.
Le en icula e e se emodeling is he mos signi ican
p ognos ic de e minan in he p og ession o DCM12 and
should be ou p ima y he apeu ic a ge 13.
Male sex and age o e 60 yea s ha e been associa ed wi h a
wo se p ognosis in pa ien s wi h DCM and HF14. On he o he
hand, highe le els o sys olic unc ion and lowe le els o
en icula dila ion a e associa ed wi h a highe likelihood o
e e se emodeling13.
Pa ien managemen equi es ollow-up by bo h p ima y ca e
and ca diology o comple e he diagnosis and ea
complica ions ha canno be ea ed on an ou pa ien basis15.
REFERENCES
I. Ga cía A, Pé ez M, Díaz B, González JR.
Mioca diopa ía dila ada. Medicine - P og ama de
Fo mación. Médica Con inuada Ac edi ando. 2021;
13 (42): 2447 - 2458.
DOI: h ps://doi.o g/10.1016/j.med.2021.09.021
II. Japp e al. The Diagnosis and E alua ion o DCM.
JACC VOL. 67, NO. 25, 2016. JUNE 28, 2016:2996
– 3010.
DOI: h ps://doi.o g/10.1016/j.jacc.2016.03.590
III. Pé ez-Se a A e al. Implemen ing a New
Algo i hm o Rein e p e a ion o Ambiguous
Va ian s in Gene ic Dila ed
Ca diomyopa hy, In e na ional Jou nal o
Molecula Sciences, 25, 7, (3807), (2024).
DOI: h ps://doi.o g/10.3390/ijms25073807
IV. Pidapa i M, Geddes GC, Du bin MD. Clinical
Gene ic and Genomic Tes ing in Congeni al Hea
Disease and Ca diomyopa hy. Jou nal o Clinical
Medicine, 13, 9, (2544), (2024).
DOI: h ps://doi.o g/10.3390/jcm13092544
V. Canna a A, F ab is E, Me lo M, A ico J, Gen ile P
e al. Sex Di e ences in he Long- e m P ognosis o
Dila ed Ca diomyopa hy. Canadian Jou nal o
Ca diology. Volume 36, Issue 1, Janua y 202, Pages
37 - 44.
DOI: h ps://doi.o g/10.1016/j.cjca.2019.05.031
VI. Begay e al. Filamin C T unca ions Al e Cellula
Adhesion. JACC. 2018; 4 (4): 504 – 14.
DOI: h ps://doi.o g/10.1016/j.jacep.2017.12.003
VII. G. Cu igliano e al. Managemen o ca diac disease
in cance pa ien s h oughou oncological ea men :
ESMO consensus ecommenda ions. Annals o
Oncology. Volume 31, Issue 2, 2020.
DOI: h ps://doi.o g/10.1016/j.annonc.2019.10.023
VIII. Cos abel JP, Mandó F, A egliano G. Mioca diopa ía
dila ada: ¿cuándo y cómo p ocede a la
in es igación e iológica? Re U ug Ca diol 2018;
33: 343-349.
IX. Rajiah e al. Nonischemic Myoca dial Disease wi h
Clinical Mani es a ions. Jou nal o he Ame ican
College o Radiology. 2021; 18: 5S.
DOI: h ps://doi.o g/10.1016/j.jac .2021.01.019
X. A belo E, e al. 2023 ESC Guidelines o he
managemen o ca diomyopa hies. Eu Hea J.
2023; 44, (37): 3503–3626.
DOI: h ps://doi.o g/10.1093/eu hea j/ehad194
Dila ed Ca diomyopa hy Seconda y o Toxici y om An h acycline Chemo he apy in a Pa ien wi h a His o y o Acu e
Lymphoblas ic Leukemia: A Case Repo
1823 Volume 05 Issue 11 No embe 2025 Co esponding Au ho : Miguel Ángel Galindo-López
XI. Pin o YM, e al. P oposal o a e ised de ini ion o
dila ed ca diomyopa hy, hypokine ic non-dila ed
ca diomyopa hy, and i s implica ions o clinical
p ac ice: a posi ion s a emen o he ESC wo king
g oup on myoca dial and pe ica dial diseases. Eu
Hea J. 2016;37(23):1850-8.
XII. Towbin e al. E alua ion, Risk S a i ica ion, and
Managemen o ACM. Hea Rhy hm, Vol 16, No
11, No embe 2019.
DOI: h ps://doi.o g/10.1016/j.h hm.2019.05.007
XIII. Escoba L, Ochoa JP, Mi elis JG e al. Associa ion
o gene ic a ian s wi h ou comes in pa ien s wi h
nonischemic dila ed ca diomyopa hy. J Am Coll
Ca diol. 2021 Oc , 78 (17) 1682-1699.
XIV. Wilde AM, e al. Expe Consensus S a emen on he
s a e o gene ic es ing o ca diac diseases. EP
Eu opace. 2022; 24 (8): 1307–1367.
DOI: h ps://doi.o g/10.1093/eu opace/euac030
XV. Amo A, Guzzo G, González E e al. Impac o
p onós ico y ac o es p edic o es de la ecupe ación
de la acción de eyección en pacien es con
mioca diopa ía dila ada alcohólica. Re Esp
Ca diol. 2018;71:612-9.
