# Reversible Heart Failure After Anthracycline and Alkylating Agent Chemotherapy

## TL;DR

A patient with breast cancer developed heart failure after chemotherapy but showed significant recovery with proper treatment.

## Contribution

This case highlights reversible heart failure following anthracycline and alkylating agent chemotherapy, emphasizing potential for recovery with medical therapy.

## Key findings

- The patient's left ventricular ejection fraction dropped to 39% after chemotherapy.
- With guideline-directed medical therapy, her ejection fraction improved to 45% at six months and 50-55% at 12 months.
- The case demonstrates that chemotherapy-induced heart failure can be reversible with optimized treatment.

## Abstract

Cardiotoxicity, including chemotherapy-induced heart failure (HF), remains a significant and well-recognised complication in modern oncologic practice. As cancer therapies evolve, treatment-related comorbidities continue to pose persistent challenges to patient outcomes and long-term survivorship. Among these, cytostatic-induced cardiotoxicity is particularly concerning due to its multifactorial and complex pathophysiology, involving oxidative stress, mitochondrial dysfunction, and direct myocardial injury. A comprehensive understanding of these mechanisms is essential for developing targeted preventive strategies and evidence-based therapeutic interventions.

We report a case of a 41-year-old Caucasian female who developed chemotherapy-induced cardiomyopathy, or heart failure with reduced ejection fraction (HFrEF), following treatment for right-sided breast cancer. Baseline echocardiogram showed normal biventricular function; however, her left ventricular ejection fraction (LVEF) declined to 39% following dual anthracycline-based chemotherapy, specifically doxorubicin and cyclophosphamide, for breast cancer. The patient was subsequently managed with guideline-directed medical therapy (GDMT). At six- and 12-month follow-up, her LVEF improved to 45% and 50-55%, respectively, demonstrating favourable cardiac recovery under optimised pharmacologic management.