Fatal Acute Right Heart Failure in Gastric Cancer Patients
A 46-year-old woman with gastric cancer presented with a 2 week period of progressively worsening shortness of breath. Six months earlier, she had a total gastrectomy. However, the adjuvant chemotherapy was not done because of her refusal. On admission, the physical examination including auscultation was unremarkable. The patient was afebrile with tachycardia of 116/min, respiratory rate of 28/min, and blood pressure of 100 /60 mmHg. Laboratory findings were remarkable for microcytic anemia and a strong positive D-dimer (11.8 μg/mL, normal <0.55). Electrocardiography showed sinus tachycardia. Echocardiography revealed feature of pulmonary artery hypertension, namely a severely dilated right ventricle with grossly impaired systolic function and an estimated pulmonary artery pressure of 52 mmHg []. Chest computer tomography (CT) presented no evidence of pulmonary emboli []. She rapidly developed hypoxemic respiratory failure and desaturated 80% on 10 liters of oxygen. The patient's condition progressively worsened and took a rapid downhill course, despite aggressive hemodynamic support. Finally, the patient developed an intractable respiratory failure and died 14 hours after hospitalization.