One Dose, One Wall: Isolated Septal Hypokinesia Triggered by First Doxorubicin Exposure.

Cardiotoxicity or cardiomyopathy is a common side effect of the use of anthracyclines for the treatment of cancer patients. Anthracyclines produce their harmful effect on the heart after several cumulative doses; however, it is rare to find the development of cardiotoxicity after only the first dose of chemotherapy. We report a case of a young male known to have acute lymphoblastic leukaemia (ALL) who developed cardiotoxicity following the first dose of doxorubicin. The patient presented with dyspnoea, orthopnoea and chest pain, and bilateral limb oedema. He had a significant hypoxaemia requiring oxygen, raised jugular venous pressure, bilateral rales and a third heart sound on examination. A transthoracic echocardiography was performed and showed a low left ventricular ejection fraction of 40%, marked left ventricular dilation and septal hypokinesia, with no global hypokinesia and normal lateral wall motion, confirming our diagnosis of anthracycline-induced cardiotoxicity following the first dose. This report discusses a rare finding of cardiotoxicity following the first dose of doxorubicin in a young male patient with ALL. Doxorubicin is known to cause dilated cardiomyopathy and global hypokinesia; nonetheless, our patient had an isolated septal hypokinesia with normal lateral wall motion. This case should raise awareness about early prevention of cardiotoxicity as it can occur early in the treatment, rather than waiting for late onset of toxicity. LEARNING POINTS: Cardiotoxicity is a life-threatening side effect of chemotherapy that can occur after the first dose.Cardiotoxicity can present in a variety of atypical presentations and findings.Anthracyclines can cause cardiotoxicity following the first dose of therapy, causing isolated septal hypokinesia.