A 59-year-old woman being treated for multiple myeloma (MM) was referred to cardiology after experiencing swelling (edema) and shortness of breath. Her symptoms began two months after starting carfilzomib, a medication used for relapsed MM. Initially, she experienced shortness of breath during physical activity, followed by facial swelling. Tests showed some heart abnormalities, but an echocardiogram suggested a different issue—pulmonary hypertension (PH), a condition affecting the lungs and heart. Right heart catheterization confirmed this diagnosis, showing high pressure in the pulmonary arteries and normal left heart function, ruling out heart failure. After stopping carfilzomib and starting treatment for PH, her symptoms improved, and tests showed reduced heart strain and pulmonary pressure.

Carfilzomib, a proteasome inhibitor used to treat multiple myeloma, can rarely cause pulmonary hypertension (PH). Physicians should monitor patients with echocardiography when starting carfilzomib, as this may help in diagnosing drug-related PH early on.