Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Do you refer patients to cardiology if they have no history of cardiac disease but will be receiving XRT with high mean doses to the heart?
Great question! Yes, we are starting to refer patients to cardiology who have Stage III NSCLC or LS-SCLC and are receiving high-dose radiation therapy. Trying to tease out whether its heart dose or central tumor location, or some combination of the two, that confers a poorer prognosis is challenging...
How would you approach the management of newly diagnosed metastatic colon cancer in a patient who experienced infusional 5FU-related cardiotoxicity with initial chemotherapy?
I have a patient who developed documented coronary spasm with EKG changes and troponin elevation on 5 FU infusion, given as part of FOLFOX cycle 1, 3 weeks ago. She is now on the FLOX regimen with Isosorbide mononitrate and amlodipine prescribed by cardiology with specific dosing and timing recommen...
Is there any role for palliative radiation in the treatment of pericardial metastases?
I love these “have you ever” questions. Somehow, as you get gray in the hair and long in the tooth, you’ve done about every weird thing and I have done a few very crazy cardiac mets over the course of my career. I was on a publication for one of the wildest ones: Kazemi et al., PMID 31993571. I’ve a...
What therapy would you recommend for metastatic myxoid liposarcoma in a young patient with anthracycline cardiomyopathy with EF 25% who failed eribulin?
I am going to guess that:1. Patient has doxorubicin cardiomyopathy because she got adjuvant doxorubicin and ifosfamide with initial tumor.2. It was long enough ago that there has been time to develop cardiomyopathy.3. If she was without progression long enough to develop cardiomyopathy you could mak...
How do you approach the re-challenge with trastuzumab in metastatic HER2+ patients who develop cardiomyopathy on trastuzumab/pertuzumab with subsequent improvement with discontinuation?
First, I send all my patients in this situation to the cardiologist. Second, I will re-start the treatment with close cardiology follow-up. Whether to re-load or not is an open question. I personally do not re-load, but I don’t think is wrong to re-load.
Would you discontinue dabrafenib/trametinib in a patient with BRAF mutant metastatic lung cancer if you see mild cardiomyopathy which could be related to the drugs?
This is a good question and a clinical scenario that I just recently ran into. The main question relates to the degree of LVEF change and whether the patient is symptomatic or not. It is not that uncommon overall. In the phase 2 trial of dabrafenib and trametinib that led to approval of this regimen...
What frontline treatment would you offer a patient with AITL who is not a candidate for an anthracycline due to baseline cardiomyopathy?
I would probably offer this patient CEOP. No data to back this up, however. Incorporation of etoposide in addition to CHOP confers a progression-free survival advantage in younger patients with PTCL, so it's reasonable to assume the etoposide would have activity.
Do you continue hydroxychloroquine in lupus patients who develop cardiomyopathy?
The short answer is yes, in that most lupus patients with cardiomyopathy do not have hydroxychloroquine drug induced cardiac injury. That is to say most of these patients either have ischemic cardiomyopathy or non-drug NICM. With that said, antimalarials can produce adverse effects both on the cardi...
What is the utility and recommendation for adding troponin and/or BNP to echocardiograms to screen for cardiac dysfunction In breast cancer patients receiving anthracycline based regimens?
For a healthy woman who received a total cumulative dose of 240 mg/m2 of doxorubicin, nothing more than a baseline echocardiogram is needed. JCO put out a clinical practice guideline in 2017 (Armenian et al., PMID 27918725) that covers the prevention and monitoring of cardiac dysfunction in survivor...
How do you balance short-course ADT in unfavorable intermediate risk prostate cancer patients with cardiac comorbidities?
One paper that addresses the topic was published in the Red Journal in 2016 (Rose et al., PMID 27788950). This retrospective analysis attempted to answer the question of which patients would derive disease-specific mortality benefit from the addition of ADT. Patients included in this analysis were f...