Acute Congestive Heart Failure Research Articles

Lupus myocarditis presenting as acute congestive heart failure : A case report

Systemic lupus erythematosus (SLE or lupus) is a disease in which the immune system attacks healthy cells and tissues throughout the body. Lupus myocarditis is a life-threatening condition, observed clinically in 3–9 % of patients with SLE. We report the case of a patient followed for multisystem SLE, presenting with de novo heart failure with severe left ventricular dysfunction revealing lupus myocarditis.

Acute Kidney Injury In Hypertensive Crisis And Acute Congestive Heart Failure

Acute Kidney Injury In Hypertensive Crisis And Acute Congestive Heart Failure

Heyde Syndrome as Cause of New-onset Heart Failure in the Setting of Bioprosthetic Aortic Valve: A Case Report

This report describes the case of a 70-year-old female with a history of bioprosthetic aortic valve replacement. She presented to the emergency department with significant shortness of breath and bilateral lower extremity edema, which was found to be secondary to new-onset acute symptomatic congestive heart failure in the setting of Heyde syndrome.

Urine sodium concentration after intravenous furosemide in dogs with acute congestive heart failure and correlation with treatment efficacy.

Poor natriuresis is a potential marker of diuretic resistance in dogs with acute congestive heart failure (CHF) but little is known about the relationship between urine sodium concentration (uNa) and frequency of successful decongestion. Supplemental O2 is a common treatment in dogs with severe CHF. The time from start to discontinuation of supplemental O2 therapy (DCSO2 ) typically reflects the time course and ease of decongestion. Urine Na concentration after IV administration of furosemide will be correlated with duration of treatment with supplemental O2 (timeO2 ) and the cumulative frequency of successful DCSO2 during hospitalization. Fifty-one dogs with acute CHF. Retrospective observational single center study. Dogs with low uNa had significantly longer mean timeO2 than dogs with high uNa (uNa <87 mmol/L, 24.2 ± 2.6 hours vs uNa ≥87 mmol/L, 16.6 ± 1.7 hours; P = .02). Low uNa was correlated with lower cumulative frequency of DCSO2 (12 hour, 28%; 24 hour, 42%; 36 hour, 73%) compared to high uNa (12 hour, 28%; 24 hour, 88%; 36 hour, 96%; P = .005). History of PO loop diuretics, low serum chloride concentration (sCl), and high PCV were associated with low uNa. Urine Na concentration outperformed other metrics of diuretic responsiveness including weight loss. Urine Na concentration after IV furosemide predicted timeO2 and cumulative frequency of DCSO2 in dogs with acute CHF, which likely reflects important aspects of diuretic responsiveness. Urine Na can assess diuretic responsiveness and treatment efficacy in dogs with CHF.

Correlation Between B line in Lung Ultrasound and Plasma NT-proBNP Level in Patients with Acute Heart Failure

Background: Acute heart failure (AHF) is a major cause of morbidity and mortality worldwide. Although this is a common cause of dyspnoea, its diagnosis still represents a challenge. Lung ultrasound (LUS) is an emerging point-of-care diagnostic tool. Objective: The aim of the study was to assess the Correlation between B line in lung ultrasound and plasma NT-proBNP level in patients with acute heart failure &amp; thus to assess the predictive value of B line in patients with suspected acute heart failure. Materials and Method: Crosssectional observational study conducted in cardiology department of BSMMU from October 2020 to September 2021. Study procedure: 36 patients presenting with of shortness of breath or heart failure diagnosis were enrolled meeting inclusion and exclusion criteria. The number of B-lines by Lung Ultrasound was measured. Correlation between number of B-lines on lung ultrasonography and NT-proBNP level were analyzed. Results: There is a positive correlation between the number of B-lines and the NT-proBNP levels (r=0.55, p&lt; 0.01) in acute heart failure patients. Conclusion: Patients presenting with acute shortness of breath with raised NTproBNP level, B line detection &amp;quantification by lung ultrasound can be used as a tool for a faster diagnosis and decision-making on lung congestion in acute heart failure. University Heart Journal 2023; 19(1): 15-19

Abstract 13086: National Trends in Timely Ambulatory Follow-Up After Acute Myocardial Infarction and Congestive Heart Failure Cospitalizations Among Medicare Beneficiaries

Introduction: Following hospitalization for acute myocardial infarction (AMI) or congestive heart failure (CHF), close outpatient follow-up is warranted for symptom monitoring and initiation or titration of evidence-based therapies. Objective: To describe temporal trends in ambulatory care following CHF and AMI hospitalizations, between 2010 and 2019. Methods: We examined a 100% sample of Medicare fee-for-service beneficiaries discharged to the community after an AMI or CHF hospitalization. We assessed quarterly rates of timely post-discharge cardiology and primary care follow-up, defined as receipt of an ambulatory visit within 14 days of discharge. We assessed trends for five subgroups based upon known disparities in cardiovascular outcomes: sex, race/ethnicity, Medicaid dual-eligibility, county-level social deprivation index, and rurality. Results: The AMI cohort included 1,680,916 hospitalizations (54.9% male, 9.4% Black, 81.7% White) and the CHF cohort included 4,256,405 hospitalizations (47.7% male, 16.2% Black, 75.0% White). Timely cardiology follow-up after AMI increased from 26.8% in 2010 to 39.4% in 2019 (absolute change 12.6%) while follow-up after CHF increased from 22.0% to 33.4% (absolute change 11.5%). The proportion of patients without cardiology or primary care follow-up after AMI decreased to 36.1% in 2019 and to 41.6% for CHF. Though rates of timely follow-up increased for all demographic groups, female, Black, Hispanic, Medicaid dual-eligible patients, patients residing in rural areas, and patients residing in counties with high social deprivation were less likely to receive follow-up throughout the study. Conclusions: Rates of timely ambulatory care after AMI and CHF hospitalization have improved, but the majority of patients do not receive follow-up within 14 days of discharge. Efforts to improve post-hospital cardiology and primary care follow-up have the potential to improve clinical outcomes and reduce disparities.

Rupture of Giant Coronary Artery Aneurysm into Left Atrium Causing Acute Congestive Heart Failure.

Rupture of Giant Coronary Artery Aneurysm into Left Atrium Causing Acute Congestive Heart Failure.

Neutrophil-to-lymphocyte ratio is increased in dogs with acute congestive heart failure secondary to myxomatous mitral valve disease compared to both dogs with heart murmurs and healthy controls.

To retrospectively evaluate neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as a biomarker for severity and short-term outcomes of congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD) in dogs. 47 dogs with CHF secondary to MMVD, 47 dogs with presumptive preclinical MMVD, and 47 control dogs. Medical record data (signalment, physical examination findings, medical treatments instituted, American College of Veterinary Internal Medicine MMVD stage, length of hospitalization, outcome, and hospital re-presentation due to CHF) from March 2012 through March 2022 for each dog were collected. Statistical analyses were performed with Mann-Whitney, Spearman correlation, and Fisher exact tests. NLR (but not PLR) was significantly higher in dogs with CHF secondary to MMVD (6.41) compared to presumptive preclinical MMVD dogs (4.66; P < .001) and control dogs (3.95; P < .001). Dogs with higher NLR and PLR received significantly higher cumulative dosages of loop-diuretic therapy during hospitalization (ρ = 0.3, P = .04; and ρ = 0.4, P = .02, respectively). There was a positive association between NLR and duration of oxygen supplementation within the CHF group (ρ = 0.4; P = .01). The increased diuretic dose and time receiving oxygen supplementation may represent increased disease severity for which NLR (and to a lesser extent PLR) may serve as a readily available marker. The data presented provide information regarding some of the systemic inflammatory changes seen in CHF secondary to MMVD in dogs. Future research should include prospective, longitudinal studies to provide insight into the long-term prognostic value of NLR and PLR in dogs with CHF.

Rational peri-operative management of antithrombotic therapy in patients undergoing radical cystectomy: A 30-day morbidity analysis based on the updated European Association of Urology guidelines for standardized complication reporting

BackgroundRadical cystectomy (RC) in bladder cancer patients with cardiovascular comorbidity poses challenges due to the need for antithrombotic therapy and high perioperative risk. We aimed to assess 30-day complications after RC in patients receiving antithrombotic therapy. Patients and methodsRetrospective study of 416 bladder cancer patients (2009–2017) undergoing open RC with pelvic lymph node dissection, with or without antithrombotic therapy. Antithrombotic therapy and complication reporting followed European guidelines. Procedure-specific 30-day complications were cataloged, graded (Clavien-Dindo), and quantified using the 30-day Comprehensive Complication Index. Multivariable regressions evaluated antithrombotic therapy's independent effect on key morbidity outcomes. ResultsMedian age was 70 years, 78% were male. Patients on antithrombotic therapy were mostly male, had higher comorbidity burden, worse kidney function, more frequent incontinent diversion, and shorter operative time (all p ≤ 0.027). Bleeding complications occurred in 135 patients (32%; 95%CI = 28–37%), more prevalent with antithrombotic therapy (46% vs. 29%; p = 0.004). Thromboembolic complications occurred in 18 patients (4.3%; 95%CI = 2.6–6.8%), no difference between patients with and without antithrombotic therapy (8.4% vs. 3.3%; p = 0.063). Prevalence of myocardial infarction, new-onset hypertension, acute congestive heart failure, and angina pectoris showed no difference (all p ≥ 0.3). Multivariable analyses indicated no association between antithrombotic therapy and cardiac complications, 30-day major complications, or cumulative morbidity (all p ≥ 0.2). Antithrombotic therapy was associated with bleeding complications (OR = 1.92; 95%CI = 1.07–3.45; p = 0.028), predominantly transfusion-related (75% of 152 bleeding complications). Limitations include retrospective data assessment with biases. ConclusionsRC in patients on antithrombotic therapy exhibits a higher incidence of adverse events due to underlying comorbidities. Adherence to thromboprophylaxis guidelines enables safe RC in patients with significant comorbidities, without substantial increase in major bleeding or severe thromboembolic events.

Tatalaksana Awal Pasien Gagal Jantung Akut Akibat Penyakit Jantung Koroner di Ruang Emergency Pelayanan Jantung Terpadu Rumah Sakit Umum Pusat Sanglah

ABSTRACT&#x0D; Acute heart failure is a clinical syndrome with a complex of symptoms that is typical shortness of breath at rest or during activity. Acute heart failure is mostly caused by coronary heart disease. Coronary heart disease is a heart failure disease with narrowed coronary arteries can be caused by the buildup of a layer of fat on the walls of the coronary arteries. The purpose of this study was to determine the initial management of patients with acute heart failure due to coronary heart disease in the Integrated Heart Service Emergency Room, Sanglah Hospital. This study is a descriptive study using a cross sectional research method on a sample of 43 people who came to the PJT Emergency Room at Sanglah Hospital with a diagnosis of acute heart failure due to coronary heart disease in 2019-2020. The data that has been obtained were then analyzed using SPSS version 24. The results showed that most of the patients 30 sample (69.77%) were male compared to women, there were 13 sample (30.23%). The majority of patients with acute heart failure due to coronary heart disease come to the Emergency Room with complaints of shortness of breath. Initial treatment given in the Emergency Room included intravenous diuretic Furosemide with a dose range of 20-80 mg/IV (93.02%), Beta blockers (2.35%), Nitroglycerin (13.95%), Digoxin (13.95%), and Dobutamine (30.23%). Most of the patients in this study were given Furosemide as an initial treatment according to the PERKI 2020 guidelines which suggest the administration of Furosemide as a treatment for fluid congestion in acute heart failure. Some patients require inotropic support such as Dobutamine which is adjusted according to individual clinical criteria. Supporting examinations were carried out on all study samples (100%) including electrocardiogram (ECG) and chest X-ray examinations.&#x0D; Keywords: Acute heart failure, Coronary heart disease, Initial management&#x0D;

Acute heart failure with incidentally found cystic adrenal mass.

Pheochromocytomas are rare adrenal tumors characterized by excessive catecholamine secretion. Symptoms and signs associated with pheochromocytomas are usually intermittent and chronic but can rarely develop into life-threatening crises. We describe a case of acute severe congestive heart failure in a previously healthy female, who recovered rapidly (4 days after admission) with acute medical therapy. The etiology on evaluation was a spontaneous bleed in a previously undiagnosed pheochromocytoma, resulting in a pheochromocytoma crisis and transient stress cardiomyopathy, followed by quick recovery of cardiac function. Our aim is to describe pheochromocytoma as a rare cause of stress cardiomyopathy. We discuss the evaluation of pheochromocytoma during critical illness and triggers/treatment strategies for pheochromocytoma crises. Hemorrhage in a pheochromocytoma can result in a pheochromocytoma crisis, with sudden release of excess catecholamines resulting in multisystem organ dysfunction and high mortality. Acute decompensated heart failure can be a rare presentation of pheochromocytoma, in a patient with no cardiac risk factors. Measurement of metanephrines in acutely stressful clinical situations can have considerable overlap with the biochemical picture of pheochromocytoma. Early imaging studies may help with the differential diagnosis. Pheochromocytoma should be ruled out before performing an adrenal biopsy. Emergent adrenalectomy in pheochromocytoma crisis results in high mortality. Medical management of the acute crisis followed by elective adrenalectomy after alpha-blockade results in better outcomes.

Phenotyping congestion in acute heart failure by renal flow and right heart to pulmonary circulation coupling.

In acute heart failure (AHF), kidney congestion is basic to treatment and prognosis. Its aetiology is manifold and quite unexplored in details mainly regarding the right heart to pulmonary circulation (Pc) coupling. We investigated the right heart to kidney interrelationship by Doppler renal flow pattern, right atrial dynamics, and right ventricular (RV) function to Pc coupling in AHF. In 119 AHF patients, echocardiographic and renal Doppler data were analysed. Univariate and multivariate regression models were performed to define the determinants of a quantitative parameter of renal congestion, the renal venous stasis index (RVSI). When grouped according to different intra-renal venous flow patterns, no differences were observed in haemodynamics and baseline renal function. Nonetheless, patients with renal Doppler evidence of congestion showed a reduced RV function [tricuspid annular plane systolic excursion (TAPSE), S'-wave velocity, and fractional area change], impaired RV to Pc coupling [TAPSE/pulmonary artery systolic pressure (PASP) ratio], and right atrial peak longitudinal strain (RAPLS), along with signs of volume overload [increased inferior vena cava (IVC) diameters and estimated right atrial pressure]. Univariate and multivariate regression analyses confirmed TAPSE/PASP, RAPLS, and IVC diameter as independent determinants of the RVSI. RVSI was the only variable predicting the composite outcome (cardiac death, heart failure hospitalization, and haemodialysis). An easy-to-use echo-derived right heart score of four variables provided good accuracy in identifying kidney congestion. In AHF, the renal venous flow pattern combined with a right heart study phenotypes congestion and clinical evolution. Keys to renal flow disruption are an impaired right atrial dynamics and RV-Pc uncoupling. Integration of four right heart echocardiographic variables may be an effective tool for scoring the renal congestive phenotype in AHF.

A Rare Case of Non-Ischemic Dilated Cardiomyopathy Revealing Inclusion Body Myositis

Inclusion body myositis is the most common inflammatory myopathy after age 50. Unlike polymyositis and dermatomyositis, in which cardiac involvement is relatively common, current evidence indicates that inclusion body myositis is not associated with cardiac disease such as dilated cardiomyopathy. We report the observation of a 57-year-old patient known to be type 2 diabetic under treatment, admitted with acute congestive heart failure. the paraclinical examinations carried out were in favor of inclusion body myositis complicated by heart failure and dilated cardiomyopathy, the patient was treated with boluses of corticosteroids and immunosuppressants as well as treatment of heart failure, this attitude has improved his symptoms as well as his quality of life. The interest of this work is to underline the importance of diagnosis and early treatment in the management of myositis complicated by cardiovascular manifestations, particularly dilated cardiomyopathy.

Radiographic lung congestion scores in dogs with acute congestive heart failure caused by myxomatous mitral valve disease.

In humans, lung congestion scores are predictive of recurrence of acute congestive heart failure (CHF) and are superior to cardiac biomarkers in predicting survival. The primary aim of this retrospective study was to determine if a modified lung congestion score (LCS) in dogs diagnosed with acute CHF because of myxomatous mitral valve disease was associated with time until recurrence or death. Complete medical records were available for a total of 94 dogs between 2010 and 2019, but only 35 dogs fulfilled the criteria for inclusion. This retrospective study used descriptive statistics to describe the cumulative and corrected LCS. Correlations were used to examine the association of the corrected LCS and time until recurrence or death, selected echocardiographic variables, and timing of furosemide administration. The mean LCS was 8.4 (SD 3.3) and corrected LCS was 0.48 (SD 0.19). The pattern was predominantly symmetric (40% of dogs) and focal (caudal) but more commonly right-sided when asymmetric (40% vs 20%). The median number of days after initial diagnosis of acute CHF to readmission and death was 150 days (range 4-572), and 266 days (range 5-965), respectively. No significant association between the dog's corrected LCS and number of days until readmission (r = .173, P = .42) nor survival (r = .109, P = .56) was found. There was a negative significant correlation (r = -.71, P < .001) between the time interval of furosemide administration and corrected LCS.

Evaluation of a New Telemedicine System for Early Detection of Cardiac Instability in Patients With Chronic Heart Failure: Real-Life Out-of-Hospital Study.

For a decade, despite results from many studies, telemedicine systems have suffered from a lack of recommendations for chronic heart failure (CHF) care because of variable study results. Another limitation is the hospital-based architecture of most telemedicine systems. Some systems use an algorithm based on daily weight, transcutaneous oxygen measurement, and heart rate to detect and treat acute heart failure (AHF) in patients with CHF as early on as possible. The aim of this study is to determine the efficacy of a telemonitoring system in detecting clinical destabilization in real-life settings (out-of-hospital management) without generating too many false positive alerts. All patients self-monitoring at home using the system after a congestive AHF event treated at a cardiology clinic in France between March 2020 and March 2021 with at least 75% compliance on daily measurements were included retrospectively. New-onset AHF was defined by the presence of at least 1 of the following criteria: transcutaneous oxygen saturation loss, defined as a transcutaneous oxygen measurement under 90%; rise of cardiac frequency above 110 beats per minute; weight gain of at least 2 kg; and symptoms of congestive AHF, described over the phone. An AHF alert was generated when the criteria reached our definition of new-onset acute congestive heart failure (HF). A total of 111 consecutive patients (n=70 men) with a median age of 76.60 (IQR 69.5-83.4) years receiving the telemonitoring system were included. Thirty-nine patients (35.1%) reached the HF warning level, and 28 patients (25%) had confirmed HF destabilization during follow-up. No patient had AHF without being detected by the telemonitoring system. Among incorrect AHF alerts (n=11), 5 patients (45%) had taken inaccurate measurements, 3 patients (27%) had supraventricular arrhythmia, 1 patient (9%) had a pulmonary bacterial infection, and 1 patient (9%) contracted COVID-19. A weight gain of at least 2 kg within 4 days was significantly associated with a correct AHF alert (P=.004), and a heart rate of more than 110 beats per minute was more significantly associated with an incorrect AHF alert (P=.007). This single-center study highlighted the efficacy of the telemedicine system in detecting and quickly treating cardiac instability complicating the course of CHF by detecting new-onset AHF as well as supraventricular arrhythmia, thus helping cardiologists provide better follow-up to ambulatory patients.

Psychological impact of first admission with cardiovascular disease in a tertiary hospital in Oman

Background and objectivesCardiovascular diseases (CVD) are associated with substantial psychological effects that can adversely influence long term prognosis. The aim of this study was to determine the psychological effect of the first hospital admission for acute coronary syndrome (ACS) or congestive heart failure (CHF) in an adult Omani population. MethodsThis cross-sectional questionnaire based study used the Hospital Anxiety and Depression Scale. Patients were recruited from the in-patient cardiology and medical wards of our institution. Patients with a prior hospital admission for CHF and ACS were excluded. The questionnaire was administered between days 3 and 7 after admission once patients were clinically stable. ResultsThe study included 116 patients (mean age 60.3 + 13.8 years; 78 (67.8%) men), comprising 52 patients with ACS and 64 patients with CHF. Based on the scores, a total of 45 (38.8%) patients had moderate to severe anxiety, and 32 (27.6%) had moderate to severe depression. Patients with severe anxiety tended to be younger, and no other factors predicted anxiety or depression. The proportion of patients with severe depression was higher among patients with CHF (31.4%), and no other differences were observed between patients with ACS or CHF. ConclusionA substantial proportion of patients admitted to our institution in Oman with CVD had severe anxiety and depression. Treating physicians and caregivers should be more open to identifying these patients, and steps should be taken to address their psychological wellbeing along with the medical management of their illness.

Infant Alstrom syndrome diagnosed by a new gene mutation: a case report.

Alstrom syndrome is a rare autosomal recessive disorder resulting from an ALMS1 gene mutation. Here, we present the clinical data of a case of an infant diagnosed with Alstrom syndrome through whole-exome sequencing. A 2-month-old male infant was admitted to Sichuan Provincial Maternity and Child Health Care Hospital on 30 May 2019 after "coughing for half a day and dyspnea for 2 hours". He was diagnosed with severe pneumonia, acute congestive heart failure, Grade III cardiac function, acute respiratory failure, and myocarditis. After treatment, he was discharged with a prescription for oral medication. After a 4-month follow-up, the patient's left ventricle exhibited spherical enlargement and a decrease in left ventricular function. The infant's whole-exome sequencing results revealed compound heterozygous mutations in the ALMS1 gene: c.2179dup (p. Y727Lfs*12), a frameshift mutation, that was heterozygous and originated from the mother, while c.11140C>T (p. Q3714*) was a heterozygous nonsense mutation that originated from the father. Both mutations are classified as "category 1-pathogenic mutations" according to the American College of Medical Genetics and Genomics (ACMG) assessment. A novel ALMS1 mutation was identified in this case report, highlighting the importance of genetic testing for the early diagnosis of Alstrom syndrome.

Large Left Ventricular Thrombus in a Patient with Methamphetamine Associated Cardiomyopathy: A Case Report

The development of small or moderate size left ventricular thrombus (LVT) is a well-known complication in various cardiac conditions with the highest rate observed in acute anterior myocardial infarction and congestive heart failure (CHF) as a result of severe left ventricular (LV) systolic dysfunction, but a huge LVT that almost protrudes to the aortic valve is an exceptionally rare phenomenon.

Rivaroxaban in patients with abdominal aortic aneurysm and high-sensitivity C-reactive protein elevation (BANBOO): study protocol for a randomized, controlled trial

BackgroundAbdominal aortic aneurysm (AAA) is a fatal disease due to the tendency to rupture. The drug treatment for small AAA without surgical indications has been controversial. Previous studies showed that high-sensitivity C-reactive protein (hs-CRP) had become a potential biomarker of the disease, and the anti-inflammatory effect of rivaroxaban for AAA had been well established. Thus, we hypothesized that rivaroxaban could control the progression of AAA in patients with hs-CRP elevation.MethodsThe study is a prospective, open-label, randomized, controlled clinical trial. Sixty subjects are recruited from the General Hospital of Northern Theatre Command of China. Subjects are randomly assigned (1:1) to the intervention arm (rivaroxaban) or control arm (aspirin). The primary efficacy outcome is the level of serum hs-CRP at 6 months. The secondary outcomes include imaging examination (the maximal diameter of AAA, the maximal thickness of mural thrombus, and the length of aneurysm), major adverse cardiovascular and cerebrovascular events (MACCE, including AAA transformation, non-fatal myocardial infarction, acute congestive heart failure, stent thrombosis, ischemia-driven target vessel revascularization, vascular amputation, stroke, cardiovascular death, and all-cause death), and other laboratory tests (troponin T, interleukin 6, D-dimer, and coagulation function).DiscussionThe BANBOO trial tested the effect of rivaroxaban on the progression of AAA in patients with elevated Hs-CRP for the first time.Trial registrationChiCTR2100051990, ClinicalTrials.gov, registered on 12 October 2021.

P280 TEAMWORK IS SUCCESSFUL (1): FAVOUREABLE RE–CHALLENGE OF DOUBLE ANTI–HER2 TREATMENT IN SEVERE MYOCARDIAL DYSFUNCTION IN PATIENT WITH ADVANCED BREAST CANCER AND OCCULT TYPE II DIABETES

Abstract Introduction Cardiovascular diseases (CVD) and Cancer (C), the most important causes of mortality worldwide. share many risk factors and common pathophysiological processes such as chronic inflammation and unfavorable cardio–metabolic profile. Progress in oncological treatments improved the survival of oncological patients (Pt) but have increased the likelihood of short– and long–term CV cardiovascular complications. The multidisciplinary collaboration between cardiologist and onco–hematologists is the task of Cardioncology, an emerging new sub–specialization of clinical cardiology that often make available personalized treatment with a favorable outcome also in clinically complex patients. Here we present a case of severe acute heart failure in a woman with advanced breast C (BC). Clinical Case 2021 April: 55–year–old woman with G3 BC, (ER 0%PgR 0%,Ki6770%HER2+) (T4N3M1), (chest wall and liver) on well tolerated treatment with Docetaxel X 6 and continuous double antiHER2 block (Trastuzumab + Pertuzumab) X 4 and steroids as ancillary therapy. After about 6 months of therapy a lower airways infection occurred and acute congestive heart failure (HF) with severe left ventricular systolic dysfunction (LVEF 25%) ensued requiring hospitalization in the ICU, where newly detected type II diabetes was diagnosed. Appropriate HF therapy with insulin and anticoagulant was established and congestive clinical state resolved. On outpatient basis B–Blocker and anti–RAAS therapy was titrated switching to empagliflozin. About 7 months after discharge, we registered the full recovery up to a normalization of systolic function (LVEF 55%) and the disappearance of the intraventricular thrombus. For progression of C, pt underwent chemotherapy with Capecitabine at metronomic and in October 2022 after cardio–oncological collegial discussion, anti–HER2 therapy resumed. Paz started Trastuzumab–Emtansine, well tolerated with substantial stability of the clinical picture (NYHA I–II) and instrumental and echocardiographic evaluation (LVEF 65%). Conclusions This clinical case reaffirms that close collaboration between cardiologist and oncologist is fundamental for the successful management of complex patients and surveillance must also extend during (and after) treatment. It also demonstrates that an early diagnosis and an "evidence–based" cardiological therapy can allow the recovery of the cardio–toxic effect of anti–HER2 drugs and may allow to resume the therapy successfully.