Day

Event

January 1990 (First presentation)

Admission with stage IIB left breast cancer. A radical mastectomy was performed, followed by radiotherapy and adjuvant chemotherapy based on anthracyclines

December 2012 (Second presentation)

Admission after an episode of syncope, and atypical chest pain

April 2013

2D-echocardiography revealed left atrial dilation with left ventricular diffuse hypokinesia and a LVEF of 45%, severe mitral regurgitation, moderate tricuspid regurgitation and mild aortic regurgitation.

May 2013

Medical treatment based on metoprolol, losartan and furosemide and the patient was discharged.

December 2013

Admission due a new episode of syncope, and dyspnea 12-lead electrocardiogram showed a complete left bundle branch block and a Mobitz II atrioventricular block

December 2013

Heart Team: Implantation of a dual chamber pacemaker, and was discharged

December 2013 to January 2020

Following 2D-echocardiography (3) showed a LVEF of 48%

January 2020

2D-echocardiography reported diffuse left ventricular hypokinesia, eccentric hypertrophy, severe mitral and tricuspid regurgitation, and LVEF of 40%.

January 2021

Follow-up echocardiogram demonstrated LV eccentric hypertrophy, diffuse hypokinesia of the LV and mild tricuspid and severe mitral regurgitation, LVEF of 39%, GLS −14%, and intermediate probability of pulmonary hypertension (PSAP of 56 mmHg).

January 2022

Last follow-up 2D-echocardiography reported an LVEF of 38%, GLS −10.9%, left atrial reservoir strain 9.5%, free-wall right ventricular longitudinal strain of −19.35% and PSAP of 47 mmHg.

February 2022

Outpatient clinic visit: The patient remains asymptomatic with a NYHA functional class II and is currently receiving optimal treatment for heart failure based on sacubitril/valsartan + spironolactone + bisoprolol + furosemide + dapagliflozine