Changes in the level of cardiomarkers in the development of acute myocardial infarction on the background of chemotherapy of a patient with tongue cancer

Abstract

Cancer is one of the leading causes of death and disability worldwide. Timely diagnosis and the introduction of new effective treatments, including intensive radiation and chemotherapy regimens, have significantly improved survival forecasts in recent years. At the same time, the use of these types of treatment increases the risk of complications, one of which includes chemotoxic cardiopathies. In this regard, timely detection and treatment of complications from the cardiovascular system in patients receiving chemotherapy courses in combination with surgical methods of treatment is important. This paper presents an assessment of the significance of the use of cardiomarkers in the early diagnosis of acute myocardial infarction that developed during chemotherapy in a patient with tongue cancer with a complicated cardiac history. Patient M., 45 years old, was admitted for surgical treatment for cancer of the tongue St. IVA, T4aN1M0, cl. gr. 2. Planned laboratory and instrumental studies were performed. Contraindications for surgical treatment were not identified. A preoperative course of chemotherapy was performed, against the background of which the patient's condition worsened with symptoms of acute cardiopathy. A second ECG was urgently performed, as a result of which an increase in the ST segment in III, aVF was established, as well as a study of the concentration of cardiomarkers: highly sensitive troponin I, N-terminal propeptide of natriuretic hormone, creatine phosphokinase MB, myoglobin, the dynamics of changes in the level of which indicated the development of acute coronary syndrome. The complex application of diagnostic procedures, including the determination of the level of cardiomarkers, made it possible to timely diagnose the development of acute type 1 myocardial infarction in a patient with tongue cancer on the background of chemotherapy. When analyzing the entire array of clinical and laboratory data, the leading initiating factor that played a decisive role in the development of myocardial infarction in this case was, in our opinion, a preoperative course of polychemotherapy with paclitaxel and carboplatin, which have cardiotoxicity. Thus, the category of patients with an initial unfavorable background, due to a common malignant process and the presence of a history of cardiodisfunction, requires more careful preparation for preoperative courses of polychemotherapy, including cardiotropic therapy with mandatory monitoring of the level of the main cardiomarkers. The most significant changes were in the levels of creatine phosphokinase MB, troponin I, and myoglobin, which were recorded in the first hours of myocardial infarction. An association was found between an increase in troponin I concentration and an increase in the ST segment of the electrocardiogram.