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=x8FNVsbnwWE

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