Nytt om faget: Kardio-onkolgi
Geeta Gulati
Lege i spesialisering kardiologi OUS-Ullevål/
stipendiat Akershus universitetssykehus
20-10-2017
Agenda
• Kardio-onkologi
• Retningslinjer
Oppav til kardio-onkolgoien
Opphav til kardio-onkologien
163 235 279 412 533
1060
1580
2250 3010
5250 5800
0 1000 2000 3000 4000 5000
Google search
«Cardio- Oncology»
Numbers
Year
- Maximize benefits of modern cancer
therapy by minimizing its deleterious effects on the cardiovascular system
- Provide recognition and treatment of
cardiac complications in patients with or
who survive cancer
9 Pillars of Cardio- Oncology
1. Myocardial
dysfunction & heart failure
2. Coronary artery disease
3. Valvular disease 4. Arrhytmias
5. Hypertension
6. Thromboembolic
7. Peripheral vascular disase & stroke
8. Pulmonary hypertension
9. Pericardial
complications
August 2016
Normal
LVEF* > 50%
Lymfom behandlet
LVEF ~ 15%
*Left ventricular ejection fraction
Kjemoterapi
• Antrasykliner (epirubicin, daunorubicin, doksorubicin)
• Trastuzumab (Herceptin®)
Kreftcelle A A A
Top* 2β
A A
Mitochondria
DNA
Vejpongsa et al, J Am Coll Cardiol. 2014 (simplified and revised)
*Topoisomerase
**Reactive oxygen species
**
Felker GM et al. N Engl J Med 2000;342:1077-1084.
Adjusted Kaplan–Meier Estimates of Survival According to the Underlying Cause of Cardiomyopathy.
HER2
HER2*
Kreftcelle
*Human epidermal growth factor receptor 2
Kardiotoksisitet
Fall i LVEF* > 10% poeng til en verdi
< 50%
*Left ventricular ejection fraction
I am a security monitor
• https://www.youtube.com/watch?v=x8FNVsbn wWE
Hvem
• Høy-risiko for å utvikle hjertesvikt
• Signifikant fall i LVEF*
Beta-blokker og ACE**-hemmer
*LVEF: left ventricular ejection fraction
**ACE: angiontensin converting enzyme
Modifisert kasuistikk
9 Pillars of Cardio- Oncology
1. Myocardial
dysfunction & heart failure
2. Coronary artery disease
3. Valvular disease 4. Arrhytmias
5. Hypertension
6. Thromboembolic
7. Peripheral vascular disase & stroke
8. Pulmonary hypertension
9. Pericardial
complications
August 2016
Cisplatin testikkelkreft og lungekreft 5-fluorouracil tarmkreft
Stråling
Brystkreft
Lymfom
Aortainsuffisiens,
parasternal langaksebilde
Aortainsuffisiens,
parasternal langaksebilde Normal aortaklaff
9 Pillars of Cardio- Oncology
1. Myocardial
dysfunction & heart failure
2. Coronary artery disease
3. Valvular disease 4. Arrhytmias
5. Hypertension
6. Thromboembolic
7. Peripheral vascular disase & stroke
8. Pulmonary hypertension
9. Pericardial
complications
August 2016
Normal 4-kammerbilde Pulmonal hypertensjon
Konklusjon
1. Kardio-onkologi er et voksende fagfelt
2. Kardio-onkologi består av 9 pillarer, med mest fokus på hjertedysfunksjon
3. Tidlig oppfølging er viktig
