A 59-Year-Old Woman With Rectal Carcinoma: Cardiovascular Considerations of Oncologic Therapy
A 59-year-old woman with a history of metastatic KRAS-positive rectal cancer with metastatic lung disease and progression of two prominent lung nodules presented for consultation for an abnormal restaging computed tomography scan of the thorax incidentally showing left ventricular (LV) and aortic thrombi (Figures 1 and 2). Her current medications were extended-release morphine, zolpidem, and mirtazapine. Her chemotherapeutic regime included capecitabine (1000 mg bid with 2 weeks on and 1 week off), which she started 9 months prior to presentation, and bevacizumab (7.5 mg weekly), which she started 5 months prior. She was initially diagnosed with rectal cancer in 2008 and had received prior surgery, chemotherapy, and radiation (right and left lung).
She was asymptomatic with no symptoms of chest pain, shortness of breath, or systemic emboli. On physical exam, blood pressure was 130/90 mmHg and pulse rate was 76 bpm. Her exam was unremarkable with a well-nourished appearing woman in no acute distress. She had no jugular venous distention and normal S1 and S2 with no murmurs, rubs, clicks, or gallops. Her lungs were clear, there was no abdominal pain, and her extremities showed no edema or cyanosis. Her distal pulses were normal, and the complete metabolic profile and complete blood count were normal. A prior electrocardiogram showed normal sinus rhythm and was within normal limits (Figure 3).
An echocardiogram (Video 1) and repeat electrocardiogram (Figure 4) were ordered. Single-photon emission computed tomography was performed and showed a moderately large, previous transmural anteroapical myocardial infarction (MI) with no residual ischemia. Overall LV systolic function was 54% with apical akinesis.
What is the most validated option for additional therapy for this patient?