2nd Edition of Cardiology World Conference

September 17-18, 2021 | Online Event

September 17-18, 2021 | Online Event

Muhammad Haris

Speaker for Cardiology Conference 2021-   Muhammad Haris
Muhammad Haris
University Hospital Morecambe Trust, United Kingdom
Title : Immune-check point inhibitors: Acute cardio-oncology challenges and concerns



Immune check point inhibitors (ICI) are increasingly used in management of cancers.Their
ultra-modern bene?ts are often over- shadowed by adverse events collectively termed as 
‘Immune- related Adverse Events’ .The incidence of ICI-Induced cardiotoxicity is
immensely under-reported and the most common presentation is Acute Myocarditis in
up-to 2.4% patients. Other manifestations include Takotsubo cardiomyopathy, VTE, 
Plaque rupture etc. We present a case of Pembrolizumab (ICI) induced Symptomatic
stable Myocarditis. 

Case Presentation: 

48 year old Gentleman with Metastatic Melanoma managed with Immunotherapy
admitted to CCU from oncology day unit with cardiac chest pain over three days. Initial
investigations revealed non-speci?c changes on ECG,Troponin-T of 474 and CRP of 14.
Chest X-ray showed mild congestion whilst Echo demonstrated normal EF and CTPA
excluded PE. An IP-Coronary Angiogram showed normal coronary arteries. Finally,
Cardiac-MRI showed edema and non speci?c in?ammatory reaction.This patient was
managed as Myocarditis with IV steroids. 

Mechanism of ICI- induced Myocarditis : 

Although Mechanism is not entirely clear.The most widely accepted hypothesis is based
on suppression of immune inhibitory receptors (overly expressed in cardiac tissue ) by
these novel agents. Certain mice models have suggested that this leads to unregulated
activation of T-cells and in?ltration of myocardium.

Diagnosis and Management of ICI-induced Myocarditis: 

ICI- induced myocarditis presents with non speci?c symptoms like chest pain and SOB
posing diagnostic challenges. Almost 100% patients present with rise in troponin. ECG,
Echo and Angiogram helps exclude ACS. Cardiac MR remains imaging modality of
choice based on Lake-Louise criteria whilst the gold standard is Endomyocardial biopsy. 

Management is based on grades of severity and involves use of steroids and
immunosuppressive therapies. Grades encompass subclinical and symptomatic (Stable,
Unstable or Decompensated) myocarditis. 

Future Considerations: 

ICI’s, although cutting-edge pose multi-system challenges that merit further research.
Concerns looming around diagnostic uncertainty with exact timings of tests to be done
needs further randomized control trials.  
What will audience learn from your presentation?  
• Acute cardio-oncology and cardio-immunology disease manifestations have always
been underreported due to dearth of solid case based evidence. Whilst
Immunotherapies have revolutionized the management of various cancers, their
systemic side e?ects still remain unexplored.

• This topic provides rare insights into the acute cardiac presentation of a drug which is
now widely used in the management of various cancers.

• The audience of this conference who will be aspiring cardiologists and acute medics will
be able to broaden their di?erential horizon when dealing with acute cardiac chest pain. 

• This presentation will also be able to initiate discussion on how immune system
modi?cation refashions various organ systems response including cardiovascular

• This case presentation will bene?t audience in a way that it will act as a ground breaking
idea for future observational and analytical studies.



Dr Haris is a young Internal medicine trainee doctor in northwest of England. He graduated in
2017 from Pakistan and is a Cardiology aspirant. He is the Valedictorian of his undergraduate
batch and is medical trainee representative of his hospital. He wishes to present this case in
forthcoming cardiology conference to increase awareness of immunotherapy related cardiac
acute presentations and to enhance his portfolio for cardiology interviews in December 2021. 

He is involved in various PubMed publications including systematic reviews and case reports. He
has worked on various topics in research ?eld including cardiology, oncology and
immunology.His abstract on “Atypical presentations of Covid-19 in frail population”  was
accepted in EGS October 2020 edition and his systematic review on  “Can Targeting Iron Help in
Combating Chronic Pseudomonas Infection?” will be placed for PMC indexing on 4/4/21.