Multiple myeloma electrocardiogram
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]; Shyam Patel [3]
Overview
There are two indications for obtaining an electrocardiogram in the workup and management of multiple myeloma: carfilzomib use and evaluation of cardiac amyloidosis. In both of these situations, a baseline electrocardiogram may be useful. Subsequent electrocardiograms may be useful for monitoring. Electrocardiogram abnormalities include atrioventricular block and low voltage QRS complexes.
Electrocardiogram
There are two indications for obtaining an electrocardiogram in the workup and management of multiple myeloma:
- Use of carfilzomib[1]: Carfilzomib is a second-generation proteasome inhibitor that is used in previously treated multiple myeloma. This medication is usually given along with either dexamethasone or the combination of lenalidomide plus dexamethasone. Carfilzomib is known to cause cardiomyopathy and cardiac toxicity. Electrocardiogram is indicated if cardiomyopathy ensues. A baseline electrocardiogram may also be useful prior to the start of carfilzomib.
- Evaluation of cardiac amyloidosis[2]: In some cases of multiple myeloma, there can be concurrent amyloidosis, which refers to systemic deposition of abnormally folded proteins called amyloid. Amyloid usually consists of lambda light chains, and amyloid can deposit in the cardiac tissue if there is excess free light chain production. Cardiac arrhythmias can occur if amyloid fibrils deposit in the electrical conduction system. This can result in low amplitude QRS complexes and heart block. Severe cardiac amyloidosis can cause significant infiltrative heart disease such that a high-degree atrioventricular block ensues. These changes can be detected readily on electrocardiogram. In some cases, serial electrocardiograms need to be done for routine cardiac monitoring.
References
- ↑ Chari A, Hajje D (2014). "Case series discussion of cardiac and vascular events following carfilzomib treatment: possible mechanism, screening, and monitoring". BMC Cancer. 14: 915. doi:10.1186/1471-2407-14-915. PMC 4289164. PMID 25471129.
- ↑ Guan J, Mishra S, Falk RH, Liao R (2012). "Current perspectives on cardiac amyloidosis". Am J Physiol Heart Circ Physiol. 302 (3): H544–52. doi:10.1152/ajpheart.00815.2011. PMC 3353775. PMID 22058156.