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Table 9. Cardiac Late Effectsa
Late Effects
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Causative Treatment
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Signs and Symptoms
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Screening and Diagnostic Tests
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Management and Intervention
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aAdapted from Schwartz et al.[37]
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Cardiomyopathy |
Chemotherapy: Anthracycline >300 mg/m2, >200 mg/m2 and radiation therapy to mediastinum, high-dose cyclophosphamide, (bone marrow transplant), and possibly ifosfamide |
Fatigue, cough, dyspnea on exertion, peripheral edema, hypertension, tachypnea/rales, tachycardia, cardiomegaly (S3/S4), hepatomegaly, syncope, palpitations, arrhythmias |
ECG, echocardiogram/ radionuclear angiography and chest x-ray baselines, every 2–5 years (depending on risk factors), Holter monitor and exercise testing baseline, as needed for symptoms and after high cumulative anthracycline dose (>300 mg/m2) |
Diuretics, digoxin, afterload reduction, antiarrhythmics, cardiac transplant, education regarding risks of: isometric exercises, alcohol consumption, drug use, smoking, pregnancy, anesthesia |
Radiation: >35 Gy |
Chemotherapy and Radiation: >25 Gy and anthracyclines |
Valvular damage (mitral/tricuspid aortic) |
Radiation: >40 Gy |
Weakness, cough, dyspnea on exertion, new murmur, pulsating liver |
Echocardiogram and chest x-ray (baseline), every 3–5 years then as needed for symptoms |
Penicillin prophylaxis for surgery/dental procedures |
Pericardial damage |
Radiation: >35 Gy |
Fatigue, dyspnea on exertion, chest pain, cyanosis, ascites, peripheral edema, hypotension, friction rub, muffled heart sounds, venous distension, pulsus paradoxus |
ECG (ST-T changes, decreased voltage), echocardiogram, chest x-ray baseline, every 3–5 years |
Pericardial stripping |
Coronary artery disease |
Radiation: >30 Gy |
Chest pain on exertion (radiates to arm/neck), dyspnea, diaphoresis, pallor, hypotension, arrhythmias |
ECG every 3 years, stress test (consider thallium scintigraphy) baseline, every 3–5 years or as needed for symptoms |
Diuretics, cardiac medications, low-sodium, low-fat diet, conditioning regimens |
References
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Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.
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