Cards: Cancer Survivors Flashcards
What cardiac side effects of radiation are known?
Chest radiation therapy is associated with significant cardiotoxicity, which can manifest as a complex, life-threatening disorder. Radiation-induced toxicity can affect nearly every component of the cardiovascular system, with manifestations such as pericarditis (acute or chronic), cardiomyopathy, aortitis, conduction system disease, valvulopathy, and coronary artery disease
How long does it take for radiation-induced cardiotoxicity to present?
Manifestations of radiation-induced cardiotoxicity frequently develop after a long indolent period (5 to 20 years or later) owing to the chronic nature of the pathology and therefore require a high index of suspicion in at-risk patients.
What chemotherapy agents cause cardiotoxicity?
Cardiotoxicity from chemotherapy can result from traditional cytotoxic chemotherapy agents, such as anthracyclines (doxorubicin, daunorubicin, mitoxantrone), as well as from newer agents, such as monoclonal antibodies (trastuzumab) and tyrosine kinase inhibitors.
Cardiotoxicity can occur in patients with normal hearts but is more common in patients with preexisting cardiac disease. Cardiotoxicity from these agents can manifest as dilated cardiomyopathy, myocardial ischemia from coronary vasospasm, or arrhythmias
What cardiac evaluation is recommended for people starting anthracyclines? Trastuzumab?
Anthracyclines: Baseline evaluation of LV EF
Trastuzumab: Baseline eval of LV EF
When should doxorubicin be stopped?
In adults undergoing doxorubicin therapy, the drug should be discontinued if there is evidence of heart failure, a 10% or greater decline in left ventricular ejection fraction to below the lower limit of normal, an absolute left ventricular ejection fraction of less than 45%, or a 20% decline in left ventricular ejection fraction to any level.
If cardiac dysfunction starts with trastuzumab, what do you do? Can you restart it? How does this compare to anthracyclines?
Cardiotoxicity related to trastuzumab is not dose related and is reversible. Antrhacyclines… it is not reversible
What is a side effect of tyrosine kinase inhibitors?
Hypertension is a potential adverse effect of kinase inhibitors that may require dose adjustment or, in patients with severe hypertension, discontinuation of the kinase inhibitor.
