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Cardiovascular Complications of Immune Checkpoint Inhibitors
Published in Shyam S. Bansal, Immune Cells, Inflammation, and Cardiovascular Diseases, 2022
Sultan Tousif, Anand Prakash Singh, Prachi Umbarkar, Hind Lal
As discussed previously, ICI-associated cardiotoxicity has been observed by a wide range of clinical manifestations. The nature of the clinical manifestation primarily depends on the extent of cardiac involvement, and therefore early diagnosis of cardiotoxic events is challenging. Hence, it is of paramount importance to develop sensitive monitoring guidelines for the early diagnosis of ICI-associated cardiotoxicity.
The Role of Exercise in Cancer Therapy
Published in Ronald R. Watson, Marianne Eisinger, Exercise and Disease, 2020
Are there limitations in oxygen delivery as a result of disease or treatment? — Patients with head and neck malignancies, as well as those with lung cancer, may have difficulty with airway obstruction or gas exchange. Further, many head and neck, as well as lung, cancer patients are current or former smokers, meaning they may have chronic obstructive lung disease as well as coronary artery disease. Pleural and pericardial effusions may be contributing factors to dyspnea. It is not uncommon for patients receiving radiation therapy or certain chemotherapeutic agents to develop pneumonitis resulting in permanent pulmonary fibrosis. Patients who receive thoracic radiation have been known to develop accelerated or premature coronary artery disease and possible myocardial infarction. Finally, drugs such as doxorubacin and cyclophosphamide can be cardiotoxic, resulting in damage to cardiac tissue. The development of an irregular or resting pulse above 100 beats per minute should be evaluated. The hematologic system may be affected by primary disease, metastases, or treatment; thus, oxygen transport may be jeopardized in several ways. Most chemotherapeutic agents have a nadir of 7 to 14 d, during which time patients are most susceptable to hemorrhage, infection, and anemia.
Overview of changes in cancer treatment strategies
Published in Susan F. Dent, Practical Cardio-Oncology, 2019
Grace Tang, Christine Brezden-Masley
There is an increasing focus on the cardiac health of patients who are undergoing or have survived cardiotoxic treatments (118). The field of cardio-oncology promotes optimal cancer treatment with a focus on limiting collateral cardiac damage (118,119). Along with the collaboration between cardiologists and oncologists, imaging specialists, clinical pharmacologists, nursing support, researchers, and educators are needed in this complex field (1). Cardio-oncology clinics allow clinicians to assess and prescribe appropriate therapeutic management if cardiac risk factors are present or if cardiotoxicity is identified (1). Figure 5.2 shows the role of a cardio-oncology service and common referrals (1). The creation of a specific cardio-oncology training program has been proposed by several experts to further advance this important therapeutic discipline (118).
Clinical experience with titrating doses of digoxin antibodies in acute digoxin poisoning. (ATOM-6)
Published in Clinical Toxicology, 2022
Betty S. Chan, Geoffrey K. Isbister, Angela Chiew, Katherine Isoardi, Nicholas A. Buckley
Acute digoxin poisoning is a rare presentation as most poisons centre would manage just a few acute digoxin poisoning per year [1]. Most previous case series of digoxin poisoning combine the results of acute and chronic digoxin poisoning [2–4], despite them being quite different clinical syndromes. People with chronic poisoning typically have multiple underlying illnesses, are prescribed multiple cardiotoxic medications and develop renal failure [5,6]. Deaths were not generally due to chronic digoxin toxicity, but were attributed to medical causes such as cardiac or respiratory failure, renal failure, sepsis or a combination of co-morbidities [6]. In contrast, acute digoxin poisoning typically involves deliberate ingestion of much larger doses by a generally healthier population and potentially requires a different management approach [7]. Pharmacokinetic modelling supported the use of less expensive and safer digoxin-Fab dosing strategies to manage acute digoxin poisoning [7].
Cannabis for cancer – illusion or the tip of an iceberg: a review of the evidence for the use of Cannabis and synthetic cannabinoids in oncology
Published in Expert Opinion on Investigational Drugs, 2019
Rare but severe events may develop in susceptible or naïve patients. Multiple reports link Cannabis consumption to cardiac toxicity, such as variability in heart rate, increased risk for myocardial infarction and other cardiovascular morbidity and mortality; these suggest reluctance in the prescription of Cannabis to patients with pre-existing heart disease or those using concomitant cardiotoxic drugs. Cannabis has also been reported to cause Cannabis hyperemesis, a variant of cyclical vomiting syndrome in the context of chronic Cannabis use, and finally toxic psychosis or paranoia [84]. A link between cannabis consumption and testicular cancer has been explored in several studies, the largest of which included 50,000 Swedish men and found higher incidence only in heavy cannabis users [86].
Treatment for beta-blocker poisoning: a systematic review
Published in Clinical Toxicology, 2020
Joe-Anthony Rotella, Shaun L. Greene, Zeff Koutsogiannis, Andis Graudins, Yit Hung Leang, Kelvin Kuan, Helen Baxter, Elyssia Bourke, Anselm Wong
To date, there are no controlled clinical studies that assess the effects of intravenous lipid emulsion in beta-blocker poisoning. There was 1 observational study, 10 case series, 5 animal studies and 21 case reports. In an observational study by Smolinske et al. [66], out of 102 overdoses involving beta-blocker toxicity and lipid therapy, only 5 (4.9%) had return of spontaneous circulation post arrest. One case series of 36 patients receiving intravenous lipid emulsion (10/36 with beta-blocker poisoning) did not show a clinical improvement in mean arterial blood pressure post lipid emulsion therapy [28]. Eleven patients died (three deaths were from a cardiotoxin – although, the authors did not define by drug class).