Fig. 4

Electrocardiographic (ECG) tracings of exercise echocardiogram performed 8 days after the 3rd dose of carfilzomib administration of the 5th cycle of treatment. Panel (a): ECG tracing at rest showing normal sinus rhythm with no significant ST-T segment abnormalities or axis deviation. Panel (b): ECG tracings at peak exercise (90% maximum predicted heart rate, 7.0 METs) demonstrating approximately 1 mm ST-T segment depressions in inferolateral leads which resolve in recovery. Patient also experienced symptoms similar to her prior dyspnea at peak exercise. Echocardiographic portion of exam showed no exercise induced wall motion abnormalities at peak exercise