Successful Management of Osimertinib-Induced Heart Failure

Figures

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  Figure 1. Chest X-ray displaying right lung consolidation (white arrow) and no pulmonary congestion (A), and electrocardiogram presenting sinus rhythm and complete left bundle branch block (B) obtained at the initial outpatient clinic visit before administration of osimertinib.

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  Figure 2. Chest X-ray showing cardiomegaly and bilateral pulmonary congestion (A) and electrocardiogram indicating remaining complete left bundle branch block and de novo poor R progression in V1–4 (B), obtained on admission following the initiation of osimertinib.

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  Figure 3. Endomyocardial biopsy obtained from right ventricular septum, displaying mild hypertrophy and size difference in myocardium and mild interstitial fibrosis (hematoxylin and eosin staining, (A) ×200, (B) ×500). Electronic microscopy of right ventricular septum, demonstrating hypertrophy and variety in size of the myocardium ((C) ×700) and small mitochondria ((D) ×10,000).

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  Figure 4. In-hospital course. sBP, systolic blood pressure; HR, heart rate; CRT, cardiac resynchronization therapy; BNP, B-type natriuretic peptide; TTE, transthoracic echocardiography, CXR, chest X-ray.

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  Figure 5. Trans-mitral left ventricular inflows obtained by Doppler echocardiography on admission (A) and following the up-titration of ivabradine (B). The overlap between the two waves are presented as red bars.

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  Figure 6. Post-discharge chest X-ray ((A), at discharge implying recurrent right lung consolidation; (B), 1 month later showing worsening consolidation; (C), following 2 months of osimertinib therapy proving remission of consolidation). White arrows show recurrent consolidation.