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Cardiac Toxicity

Cardiac Toxicity. Objective. The learner will be able to describe cardiac toxicity, including its major causes, assessment, and management. Causes. Chemotherapy

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Cardiac Toxicity

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  1. Cardiac Toxicity

  2. Objective The learner will be able to describe cardiac toxicity, including its major causes, assessment, and management.

  3. Causes • Chemotherapy • Many chemotherapuetic agents can affect the heart. The most common are anthracyclines, cyclophosphamide, taxanes, immunotherapies, and monoclonal antibodies. • Radiation therapy • Areas treated if the heart is in the field

  4. Chemotherapy • Direct damage to the muscle fibers from drug • Arrhythmias or spasms caused by high doses • Damage to the lining of the blood vessels • Radiation therapy • Radiation directly to the heart tissues can cause inflammation that can lead to fibrosis. • Damage to the lining of the blood vessels and collagen deposits can cause cardiomyopathy, coronary artery disease, or dysfunction of the valves.

  5. Signs and Symptoms • Shortness of breath (SOB) • Chest pain • Fatigue • Edema • Syncope • Arrhythmias • Quality-of-life changes • “I can’t do what I used to do.” • Depression

  6. Assessment • Heart sounds and rhythm • Murmurs, rubs, irregular or extra sounds • Signs of congestive heart failure • Fluid overload—Edema, vein distention, weight gain, breath sounds • Tachycardia, SOB, cough, cardiomegaly • Electrolyte status • Potassium and calcium levels can affect heart function.

  7. Assessment (cont.) • Electrocardiogram (EKG) • Assess heart rhythms. • Echocardiogram or multiple-gated acquisition (MUGA) scan • Assess function of heart and valves, and look for fluid around the heart. • Blood level of troponin • Assess for heart muscle tissue damage.

  8. Prevention • Limit doses of chemotherapy and radiation. • Know pretreatment/baseline cardiac status. • Perform ongoing assessment and treatment of any signs of cardiac dysfunction. • Educate patients and families about signs and symptoms to report.

  9. Management • Dexrazoxane can be given with some chemotherapy to protect the heart. • Dose reduction may be necessary. • Diuretics for fluid overload • Oxygen • Beta-blockers, vasodilators, and other cardiac medications to support heart function • Cardiology consult

  10. Management • Provide rehabilitation. • Avoid tobacco, caffeine, and alcohol; these stimulate heart muscle and can cause dehydration. • Avoid salt if fluid overload is a problem. • Provide ongoing monitoring of EKG and MUGA scan for cardiac status. • Provide psychosocial support, as cardiac dysfunction can be disabling. • Educate patients and family members on how to manage the condition and what to report to the physician.

  11. References Held-Warmkessel, J. (2009). Cardiac, gastrointestinal, neurologic, and ocular toxicities. In B.H. Gobel, S. Triest-Robertson, & W.H. Vogel (Eds.), Advanced oncology nursing certification review and resource manual (pp. 443455). Pittsburgh, PA: Oncology Nursing Society. Moore-Higgs, G. (2005). Site-specific management—Thoracic. In D.W. Bruner, M.L. Haas, & T.K. Gosselin-Acomb(Eds.), Manual for radiation oncology nursing practice and education (3rd ed., pp. 113115). Pittsburgh, PA: Oncology Nursing Society. Shelton, B.K. (2009). Side effects of cancer therapy—Pulmonary toxicity. In M. Polovich, J.M. Whitford, & M. Olsen (Eds.), Chemotherapy and biotherapy guidelines and recommendations for practice (3rd ed., pp. 231255). Pittsburgh, PA: Oncology Nursing Society.

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