Supplementary Material for: Abrupt onset of septic cardiomyopathy in a cancer patient initiated on chemotherapy: A case report and literature review

Background: Sepsis induced cardiomyopathy (SICM) develops in 18-65% cases of sepsis, and its presence in septic shock increases the mortality rate by 70% to 90%. The hallmark of SICM includes global hypokinesia which causes increased LV end-diastolic volume and reduced left ventricular ejection fraction (LVEF), and is reversible by 7 to 10 days provided the patient survives. Case presentation: In this report, we discuss a case of myocardial dysfunction occurring in neutropenic sepsis eventually leading to ventricular arrhythmia which proved fatal. The clinical finding in this 39 year old male cancer patient (without pre-existing heart disease) was consistent with SICM triggered by chemotherapy induced neutropenic sepsis. His ECHO findings were characteristic with left ventricular changes of reduced EF, global hypokinesia, and ventricular dilation on the second/final day of admission. The discourse encompasses issues associated with maintaining hemodynamic stability in the concerned scenario, as well as distinguishing SICM from other cardiac diseases. Conclusions: Among cancer patients, the dose of chemotherapy infusion needs to be optimized. LVEF as a diagnostic tool is reported as a poor measure of SICM prognosis, and needs to be replaced with a sensitive and specific measure such as global longitudinal strain (GLS). The management includes optimizing the strategies such as treating the underlying infection, supportive care measures such as fluid replacement, oxygen therapy and medications for improving the functioning of heart (vasopressors and inotropes).