Heart failure in a young patient with multiple myeloma-related kyphosis: a case report

Abstract

Heart failure in patients with multiple myeloma (MM) is uncommon and usually occurs secondary to amyloidosis or treatment-related cardiotoxicity. We report a case of a 34-year-old male with MM who developed severe thoracolumbar kyphosis leading to heart failure with mildly reduced ejection fraction (HFmrEF). The patient presented with progressive exertional dyspnea, dizziness, fatigue, and chronic back pain. Clinical findings included marked kyphotic deformity and jugular venous distension. Laboratory examination revealed normocytic anemia, hypoalbuminemia, and a monoclonal protein spike. Radiological evaluation showed multiple vertebral compression fractures with significant kyphotic angulation, while echocardiography revealed an ejection fraction of 45%. Pulmonary function testing demonstrated restrictive ventilatory impairment. The diagnosis of MM was confirmed by bone marrow aspiration. The development of HFmrEF in this case was attributed to extrinsic mechanical restriction caused by spinal deformity, which impaired thoracic expansion and cardiac preload, despite the absence of myocardial infiltration or amyloidosis. This case highlights the importance of early cardiopulmonary assessment in MM patients, even among younger individuals, to optimize management before initiating chemotherapy. Awareness of mechanical thoracic restriction as an uncommon but clinically significant cause of heart failure in MM should influence treatment planning and improve overall prognosis.