Fatal Acute Right Heart Failure in Gastric Cancer Patients
A 48-year-old man presented with a 2 week history of rapid progressive exertional dyspnea. His gastric cancer had been diagnosed 1 year previously and was treated with gastrectomy and chemotherapy. On physical examination, the patient was afebrile with respiratory rate of 25/min, and blood pressure of 100/60 mmHg. Electrocardiography showed sinus tachycardia. Echocardiography revealed a right ventricular overloading sign with an elevated pulmonary artery pressure of 70 mmHg. Laboratory results showed microcytic anemia and an elevated D-dimer serum level (19.1 μg/mL, normal <0.55). Chest CT presented no evidence of pulmonary thromboembolism. Ten hours after hospital admission, the patient's state rapidly deteriorated, with increasing dyspnea, peripheral cyanosis. He showed poor response to the initial management with oxygen and continuous positive airway pressure. He progressed to cardiogenic shock and had no improvement with a vasoactive drug. He had persistent hypoxemia. He died from refractory right heart failure caused by pulmonary artery hypertension.