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Rare but frequently fatal inflammation of the heart muscle triggered by checkpoint inhibitors, usually in the first two months. It often comes with muscle and nerve-muscle inflammation, and needs urgent high-dose steroids.
Occurs in about 1% of patients (more with combination CTLA-4 plus PD-1 and with some other combinations) with mortality of 25-50%; presents with chest pain, breathlessness, arrhythmia or heart block, often alongside myositis and myasthenia (the 'triad'). Diagnosis rests on troponin, ECG, echocardiography, cardiac MRI and biopsy; treatment is immediate methylprednisolone with abatacept, mycophenolate or ruxolitinib for steroid-refractory cases, and the drug is permanently stopped. Baseline and early troponin monitoring is debated. Distinct from anthracycline and trastuzumab cardiomyopathy, which damage the heart without inflammation.
Showing the technology this term belongs to: Immune checkpoint inhibitors.
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