Mavacamten for Obstructive HCM in Malignancy With Life-Threatening Symptoms

Background A 79-year-old woman admitted to critical care with obstructive hypertrophic cardiomyopathy and metastatic pancreatic neuroendocrine tumor presented with recurrent pulmonary edema and hemodynamic compromise from dynamic left ventricular outflow tract obstruction.Case summary Mavacamten was initiated, leading to rapid symptomatic improvement. However, during the course of treatment, the patient developed marked liver enzyme elevation, raising concern for drug-induced liver injury or an alternate oncological diagnosis.Discussion Multidisciplinary discussion was essential for reaching the final diagnosis of biliary obstruction and restarting mavacamten, breaking the vicious circle of recurrent presyncope and pulmonary edema secondary to dynamic left ventricular outflow tract obstruction.Take-home message Multidisciplinary decision-making is paramount when considering novel therapies in complex cardio-oncology patients.