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Assessing and responding to sudden deterioration in the adult
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
You read that Mrs Patel had a cardiac monitor attached postoperatively. The paramedics would have attached cardiac monitoring to Mary, which will be continued on her arrival at the hospital. Cardiac monitoring is carried out for many acutely ill individuals and where heart rhythm is, or may become, abnormal (e.g. cardiac conditions, electrolyte imbalance, poisoning, hypothermia). You may have seen this equipment on placement or in the skills laboratory.
The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Investigations required for the patient with cardiogenic shock are based upon the evaluation of the extent of the damage to the heart and the effect that this has on the major organs of the body and include: Echocardiography to reveal the amount of ventricular damage that exists and the functioning of heart valves also affected. The presence of blood in the pericardium can be seen.12 lead ECG to show ST segment elevations in the region of an infarction, which is important for the consideration of the complications that might arise from it. For example, ST segment elevations in the leads V1 to V3 indicate an antero-septal MI, which is implicated in septal wall rupture.Cardiac monitoring, used continuously to quickly identify changes to the heart’s rhythm. Arrhythmia might occur because of the damage to the ventricular wall, or as a result of changes in blood chemistry caused by renal hypoperfusion.Cardiac catheterisation is a commonly used technique for the evaluation of coronary artery blood flow to the affected region of myocardium.
Toxicology
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Admit all patients with signs of toxicity for cardiac monitoring. Refer patients with severe toxicity, obtundation and seizures to ICU for haemodialysis or charcoal haemoperfusion.
Guidelines for non-transplant chemotherapy for treatment of systemic AL amyloidosis: EHA-ISA working group
Published in Amyloid, 2023
Ashutosh D. Wechalekar, M. Teresa Cibeira, Simon D. Gibbs, Arnaud Jaccard, Shaji Kumar, Giampaolo Merlini, Giovanni Palladini, Vaishali Sanchorawala, Stefan Schönland, Christopher Venner, Mario Boccadoro, Efstathios Kastritis
Anti-clonal therapy alone may not suffice for such patients, even when haematologic response is rapid, as early mortality may be as high as 50% following therapy initiation [1]. Close collaboration with the heart failure clinic is mandatory, and cardiac transplantation should be discussed for younger patients, especially those with isolated cardiac involvement. Immediate treatment initiation is crucial. Dose modification of bortezomib and/or dexamethasone or sequential introduction of drugs should be considered as appropriate [51]. Daratumumab, if available, is proposed as the preferred option, even starting as single agent;preliminary data of an ongoing European phase II trial show early and deep haematologic responses and encouraging improvement in survival [52]. Intravenous daratumumab may be given in divided doses to reduce fluid volume but the subcutaneous formulation is preferred. Close monitoring is needed and inpatient treatment administration is advised. The advantage of initiating treatment with continuous cardiac monitoring is unclear. Addition of a third agent to bortezomib-dexamethasone may accelerate haematologic response: cyclophosphamide and melphalan are usually well tolerated and daratumumab is, again, preferred. IMiDs are associated with significant toxicity in these patients and should be avoided unless there are contraindications to bortezomib and no access to daratumumab.
Safety considerations with the current treatments for peripheral T-cell lymphoma
Published in Expert Opinion on Drug Safety, 2022
Tarsheen Sethi, Francesca Montanari, Francine Foss
Furthermore, EKG abnormalities have been reported as a class effect with HDAC inhibitors [23,24]. In the Phase II registration study of romidepsin in PTCL, EKG changes were uncommon (n = 8, 6%), with four patients (3%) reporting asymptomatic QTc prolongation (three patients with grade 1/ 2 and one patient with grade 3 QTc prolongation). In addition, review of the QTcF and QTcB intervals over the first four cycles did not reveal any clinically significant changes across treatment cycles for these parameters. The FDA label includes a recommendation to check potassium and magnesium levels and repletion and avoidance of concurrent use of other QTc prolonging drugs. Additional cardiac monitoring would be reasonable for those with history of heart disease. In our practice, we obtain EKGs before and after each dose of romidepsin in cycle 1 and if patients have no significant QTc prolongation, further EKGs are only obtained if patients report cardiac symptoms. In additional, data from the registration trial of romidepsin showed an increase in AEs with more prior patients who had lines of therapy (61%, 66%, and 75% for 1, 2, and ≥ 3 lines of treatment, respectively) [25]. Most common AEs leading to drug withdrawal were thrombocytopenia and pneumonia (each n = 3). Recent studies have shown low dose romidepsin to reverse HIV latency and promote viral replication, and earlier studies demonstrated similar effects on EBV transcription. As of this review, romidepsin has been withdrawn from the market for the indication of R/R PTCL.
Guidelines for high dose chemotherapy and stem cell transplantation for systemic AL amyloidosis: EHA-ISA working group guidelines
Published in Amyloid, 2022
Vaishali Sanchorawala, Mario Boccadoro, Morie Gertz, Ute Hegenbart, Efstathios Kastritis, Heather Landau, Peter Mollee, Ashutosh Wechalekar, Giovanni Palladini
Stem cell mobilisation should be performed preferably with GCSF +/− plerixafor.Patients with significant cardiac involvement and CHF should undergo stem cell mobilisation with GCSF and planned plerixafor to avoid excessive fluid retention.Patients should be assessed daily (before and after stem cell collection) during this phase and volume overload should be managed with intravenous loop diuretics.Use of cardiac monitoring/telemetry is recommended in patients with cardiac involvement and CHF, hypotension, presyncope or arrhythmia.Hypotension from autonomic neuropathy should be managed with midodrine, compression stockings, prevention of intravascular volume depletion and droxidopa.