Cardiooncological balance in a 75-year-old male with a hepatocellular carcinoma CS IV and a congestive heart failure NYHA III „de novo”

The case reports about a 75-years-old man without a previous medical history, in whom a heart failure NYHA III de novo was diagnosed together with persistent atrial fibrillation and hepatocellular carcinoma in clinical stage IV. Based on echocardiography and computed tomography there were pulmonary hypertension in course of lymphangiosis carcinomatosa as well as diffuse metastases in the abdomen diagnosed. Before the treatment initiation the patient was classified 3 in WHO performance status. After an improvement in control of the rhythm frequency and the heart failure treatment stabilisation with a β-blocker, an ACE-inhibitor, spironolactone and furosemide, the patient’s performance status improved to WHO 2. He was further disqualified from surgical procedures due to the advanced clinical stage of the oncological disease. Considering high probability of further cardiotoxic influence of sorafenib on the heart failure despite its satisfactory control, the patient was assigned to palliative chemotherapy with FOLFOX. Parallel he was strictly followed up cardiologically in an outpatient clinic what certainly supported the oncological treatment. The patient survived 32 weeks from the first hospitalization and the progression free survival was 12 weeks from the chemotherapy initiation.