Cardiotoxicity

Introduction Yeh, a professor of cardiology at the University of Texas MD Anderson Cancer Center, reported on June 29th that cancer treatment, including the most commonly used chemotherapeutics and the latest biological and targeted therapies, may cause damage to the patient's heart. It even leads to the death of the patient. However, for the cardiotoxicity of anticancer drugs, many physicians have not fully monitored and have not taken corresponding preventive measures. This large-scale study led by Yeh summarizes the 30-year experience of the MD Anderson Cancer Center and a number of recent studies on cardiotoxicity of anticancer drugs, detailing the cardiac complications of anticancer therapy and its prevention and treatment. Yeh said the findings are important because physicians and patients may not understand what cardiotoxicity is produced by anticancer treatments, and many of them are preventable. He said that in fact, cardiotoxicity is more harmful to many cancer patients than cancer. In the study, the researchers reviewed 29 anticancer drugs and found that all kinds of anticancer drugs are likely to produce cardiotoxicity, without exception. The heart seems to be particularly sensitive to the toxicity of cancer drugs.

Cause

In general, cardiotoxicity is most dangerous for elderly patients and patients with other diseases (such as diabetes, high blood pressure, etc.) or those with previous heart disease. However, all living patients may have cardiotoxic effects of anticancer drugs. Cardiotoxicity may occur during the treatment of the disease, or may occur several months or even years after treatment.

an examination

Related inspection

Dynamic electrocardiogram (Holter monitoring)

Cardiac toxicity of anticancer drugs may occur in surviving patients. Cardiotoxicity may occur during treatment or in the months or even years after treatment.

Electrocardiogram: In each cardiac cycle, the heart is excited by the pacemaker, the atria, and the ventricle. With the changes in bioelectricity, various forms of potential change patterns (ECG) are extracted from the body surface through the electrocardiograph. An electrocardiogram is an objective indicator of the process of cardiac excitability, transmission, and recovery. Electrocardiogram is the earliest, most commonly used and most basic diagnostic method for the diagnosis of coronary heart disease.

Holter: It is a method that continuously records and compiles ECG changes in the active and quiet state for a long time. Also known as Holter monitoring.

Differential diagnosis

Bacterial endocarditis: An acute or common subacute disease that forms a septic growth thrombus in the valve and endocardial wall, which subsequently develops into a transient or persistent bacteremia. Thrombosis often affects the aortic valve, for example, the aortic valve of an animal may be damaged by a stenosis of the accessory aorta. The tendon formed on the flap is fragile and tends to form an embolus. Damage may alter the structure and function of the valve, which may lead to reflux and/or stenosis of the heart, eventually leading to symptoms of congestive heart failure. It has been reported that the disease has an increasing trend in medium and large male dogs older than 4 years old.

Concentric virus infection: common in viral myocarditis, refers to the human infection with a heart-to-heart virus, causing non-specific interstitial inflammation of the myocardium. It may be localized or diffuse; the course of the disease may be acute, subacute or chronic. Most patients with acute viral myocarditis can return to normal, with few sudden deaths, and some chronically developed viral myocarditis can evolve into cardiomyopathy. Some patients have sequelae after myocardial scar formation: a certain degree of heart enlargement, cardiac dysfunction, arrhythmia or persistent abnormal ECG.

Symptoms of systemic infection: It is due to the interaction between the body and the pathogen. Because the immune function of the body is weak, the pathogen cannot be localized, so that the pathogen and its toxin spread to the surrounding area, and the lymphatics or direct invasion of the bloodstream causes systemic infection. Pus or body fluids should be obtained from all infected sites, including infected body cavities, joint spaces, soft tissues, and diseased skin for Gram staining and culture. Blood culture should include aerobic and anaerobic cultures. Blood culture should be performed twice a day at intervals of one hour. Blood should be taken from different sites at each time. Two blood cultures are sufficient for the initial diagnosis of bacteremia, but negative staining or culture results cannot exclude bacteremia, especially in patients who have previously received antibiotics, and cannot exclude bacteremia. This specimen of at least 2 blood cultures should be taken from a properly prepared venous incision site. In addition, specimens of sputum, catheter insertion sites and wounds can be cultured.

Pericardial constriction: Chronic constrictive pericarditis is mostly caused by tuberculous pericarditis. Acute suppurative pericarditis is about 10% of the prolonged unhealed, others can be caused by rheumatism, trauma, mediastinal radiotherapy, etc., accounting for a very small number. The most common cause of inflammation in China is tuberculosis and suppurative infection followed by mold or viral infection. X-ray examination: the heart shadow size is normal or slightly larger, the heart enlargement may be due to pericardial thickening or pericardial effusion, the normal arc of the left and right heart disappears, it is flat and stiff, the heart beats weakened, and the superior vena cava is obviously widened. Some patients have calcified eggshells in the pericardium. In addition, the atrial enlargement is seen.

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