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Cancer Therapies and Cardiac Dysfunction
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Victoria Shklar, Katherine Godfrey, Michelle E. Bloom
The American Society of Clinical Oncology (ASCO) recommends baseline EKG for all patients, and consideration of troponin, especially with combination therapy.66 For patients with high clinical suspicion of cardiac toxicity, cardiology consultation and additional cardiac testing are recommended, including cardiac magnetic resonance imaging (MRI), cardiac catheterization, and endomyocardial biopsy, when appropriate. Treatment includes permanent discontinuation of ICI therapy, hospital admission, and high-dose steroids (methylprednisolone 1 g/day × 3 days), with the potential addition of other immune-modulating therapies, such as mycophenolic acid, infliximab, or anti-thymocyte globulin.66
Overview of current guidelines
Published in Susan F. Dent, Practical Cardio-Oncology, 2019
Serial measurement of LV function, in particular LVEF, is the most commonly applied modality used to detect cardiotoxicity. Transthoracic echocardiography (TTE) is typically the method of choice due to its availability and reproducibility. TTE also has additional advantages; there is no radiation exposure to the patient and the right ventricle, valves, and pericardium can be assessed (4–6). Cardiac magnetic resonance imaging (MRI) or a MUGA scan can be used if TTE is not technically feasible or available.
Electrocardiogram, chest radiograph, and ancillary investigations
Published in Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi, Mitral Stenosis, 2018
Arun Sharma, Kanika Bhambri, Gurpreet S. Gulati, Neeraj Parakh
Cardiac magnetic resonance imaging (MRI) is valuable for its ability to provide hemodynamic data in those patients where echocardiographic assessment is inadequate. It remains the gold standard investigation for providing reproducible measurements of ventricular volumes, mass, and function. It also depicts LA size, volume, wall thickness, and presence or absence of mass lesion (Figures 7.14 and 7.15) or thrombus.63,64 The differentiation and characterization of associated thrombus from the mass lesion are much better on MRI. Delayed enhanced imaging is the technique of choice for detecting and quantifying LA fibrosis or scar.
Decision making in anomalous aortic origin of a coronary artery
Published in Expert Review of Cardiovascular Therapy, 2023
Hitesh Agrawal, Alexandra Lamari-Fisher, Keren Hasbani, Stephanie Philip, Charles D. Fraser, Carlos M. Mery
A comprehensive clinical evaluation is paramount to help define the optimal management of a particular patient (Figure 5). Patients suspected to have AAOCA generally undergo an electrocardiogram and an echocardiogram by their referring cardiologist. At our program, further clinical evaluation is performed by a core group of cardiologists. The evaluation includes both anatomical and functional testing. Anatomical testing includes an electrocardiogram-gated CTA given the superior spatial resolution of CTA over other cross-sectional imaging modalities (Figure 2). Noninvasive functional testing includes a metabolic exercise stress test, a dobutamine/atropine stress cardiac magnetic resonance imaging (sMRI), and chest magnetic resonance angiography (MRA). Evaluation also includes a fasting lipid profile (Figure 5) and occasionally cardiac catheterization is utilized.
Eosinophilic granulomatosis with polyangiitis
Published in Postgraduate Medicine, 2023
Once the diagnosis of EGPA is established it is very important to complete evaluation to determine the extent and severity of organ involvement. Cardiac disease is the leading cause of death in EGPA and all patients should have a screening echocardiogram at the time of diagnosis [38,39]. Cardiac magnetic resonance imaging (MRI) is considered more sensitive than echocardiogram in the screening of myocarditis and should be considered if clinically indicated. The combined use of multiple modalities estimates a prevalence of 60% to 90% of cardiac abnormalities in EGPA patients thought to be in remission [40–42]. Although cardiac MRI is considered a better test for myocardium visualization, it does not always provide a clear distinction between myocardium inflammation and fibrosis in EGPA [43].
Cardiovascular sequelae of dengue fever: a systematic review
Published in Expert Review of Cardiovascular Therapy, 2022
Abdur Rahim, Ali Hameed, Uzma Ishaq, Jahanzeb Malik, Syed Muhammad Jawad Zaidi, Hajra Khurshid, Asmara Malik, Danish Iltaf Satti, Hifza Naz
Diagnosis of CV manifestations of dengue can be difficult as many arrhythmias or underlying CV pathology can be asymptomatic. Therefore, we suggest that initial ECG and echocardiography should be performed, especially in patients with moderate-to-severe DF. However, if a patient develops any of the CV signs and symptoms with a confirmed diagnosis of dengue on RT-PCR, dengue serology, or NS1 antigen testing, an ECG can be very helpful in determining the underlying arrhythmias in mild cases as well. If the ECG is normal, the patient should be clinically reassessed even after recovery because subtle ECG changes can occur after the recovery [46,48,55]. If the symptomatic patient has an abnormal ECG, transthoracic echocardiography is recommended to evaluate valvular abnormalities, pericardial involvement, or myocarditis. In the case of normal transthoracic echocardiography, cardiac magnetic resonance imaging is recommended [94]. Timely detection of myocardial injury during DF should be the core objective of the clinician and a holistic approach using clinical correlation with laboratory parameters are an absolute necessity for the management of DF.