Managing cardiotoxicity during chemotherapy treatment


Bone marrow transplantation and also the utilization of colony-stimulating factors are hematologic strategies used in the treatment of cancer, enabling dose intensification. They boost the sensitivity of myocardial cells to chemotherapy, causing a heightened possibility of acute, chronic, and perhaps irreversible cardiac damage.

Negative effects towards the cardiac system are mainly related to an-thracycline therapy, particularly doxorubicin and daunorubicin. Cardiac alterations might be acute or chronic, and manifestations can vary from subtle ECG changes to life-threatening cardiomyopathies for example arrhythmias, congestive heart failure, and ischemia.

Cardiotoxicity might be potentiated by concomitant mediastinal radiation and also the utilization of other potentially cardiotoxic drugs, for example high-dose cyclophosphamide. Other risk factors are age, preexisting cardiac disease, smoking, malnutrition, renal and hepatic impairment, along with a good reputation for hypertension.

The clinical presentation of cardiotoxicity resembles that of congestive heart failure. The individual has dyspnea along with a non-productive cough. Other manifestations are distended neck veins, ankle edema, tachycardia, and cardiomegaly. The utilization of the new cardiac protectant, dexrazoxane, in doxorubicin therapy for advanced breast cancer may help diminish the incidence of cardiac toxicity. In severe cases, the chemotherapeutic agents should be discontinued and supportive measures provided.

onitor the patient's cardiac function by obtaining cardiac enzymes, multigated radionuclide angiography, and electrocardiograms before and throughout treatment. Obtain baseline assessments of the peripheral and apical pulse, blood pressure level, the existence of edema, and difficulty with breathing or heart problems. Teach the individual to report signs or symptoms suggestive of early cardiac problems, for example tachycardia, dyspnea, and dizziness.

Stress the significance of a low-salt diet, fluid restriction to 1 L/day, and rest periods when the patient develops congestive heart failure. Administer cardioprotectants for example dexrazoxane if ordered. Limit the cumulative chemotherapy dose based on guidelines, with dose reductions when the patient gets concomitant irradiation.

Instruct the individual concerning the need for taking digoxin and diuretics and also the associated negative effects if these medications are ordered. Teach the individual to prevent alcohol and tobacco due to their stimulant effect on the heart muscle. Measure the patient's activity and develop a suitable plan.

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This article was sent to us by: Duane Owens at 07262011

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