(Kiosk 1) Palliative Rehabilitation of Stage IV Prostate Cancer with Tachycardia: A Case Report

Case Diagnosis: Inappropriate Sinus Tachycardia (IST) in Stage IV prostate adenocarcinoma with diffuse bony metastasis

Case Description or Program Description: A 46-year-old male presented with lumbar pain, lower extremity weakness, frequent falls, and urinary retention. Radiographic imaging of the spine revealed extensive metastatic disease with epidural tumors throughout T3-7, T9, T11-12, and L1-3. Neurosurgery performed T6-T7 laminectomy to alleviate cord compression, with subsequent improvement in lower extremity strength and urinary symptoms.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: When medically stable, the patient was admitted for acute rehabilitation. His hospital course was complicated by asymptomatic, persistent sinus tachycardia up to 120 beats per minute (BPM). His tachycardia work-up involved chest CT angiogram (negative for pulmonary embolism), dopplers of all extremities (negative for deep venous thromboembolism), thyroid studies (normal), echocardiogram (normal), and cell blood count (mild anemia with no improvement after transfusion). Fluid challenges were done with no improvement in heart rate. With no obvious pathologic cause of his tachycardia, IST was diagnosed. Therapy was continued with heart rate precautions (at rest < 120 BPM), and was frequently adapted to bedside. He completed 12 days of rehabilitation with minimal functional improvement before being discharged to inpatient medicine for worsening tachycardia.

Discussion (relevance): Sinus tachycardia is commonly caused by clot burden, thyroid disease, infection, heart strain, pain, anemia, dehydration, and medications. IST is a diagnosis of exclusion, warranting a thorough evaluation. Cancer is associated with a pro-inflammatory state, and may manifest with cardiac signs including tachycardia. Severely increased, chronic tachycardia increases the risk for development of cardiovascular disease including cardiomyopathy and heart failure with reduced ejection fraction, warranting close medical monitoring.

Conclusions: Palliative rehabilitation emphasizes improving quality of life and maximizing function. This case demonstrates the importance of a tachycardia work-up to rule out common causes, and cardiac monitoring in acute rehabilitation of a patient with active cancer and persistent sinus tachycardia due to the increased risk of cardiac morbidity and mortality.