*Corresponding Author: Ruchika Kalra, Amity Institute of Physiotherapy, Amity University Noida, Uttar Pradesh, India.
Citation: B Anand, R Kalra. (2021) Association of Chemotherapeutic Drugs and Ecg Changes: A Review. Journal of Clinical and Laboratory Research 3(3); DOI:10.31579/2768-0487/044
Copyright: © 2021 Ruchika Kalra. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 13 August 2021 | Accepted: 04 September 2021 | Published: 11 September 2021
Keywords: chemotherapy; cancer; electrocardiogram
Abstract
Cancer is not only the challenging disease but the treatment is so the same. Chemotherapy is the treatment plan that is included as an essential treatment which increases the chances to live in serious cancer stages and their types but chemotherapy induced cardiac dysfunction is the life-threatening complications leading to electrophysiological dysfunctions presented at Electrocardiogram. Studies have presented that Chemotherapy is the cause around 5% of cardiac-toxicities and near 4% the reason of cardiac death in cancer. This study aims to review the literature behind the effect of chemotherapy on the electrocardiogram and its alterations see at various stages and types of cancer. The research literature was extracted the data from Google scholars, PubMed, Medline, and Cochrane. Various alterations on ECG parameters that were QTc prolongation, abnormal ventricular repolarization, increased heart rate, QRS complex abnormalities and the severity to the disease was seen in the increased in stage of cancer as early the cardiac toxicity was noticed and delayed in early cancer diagnosis.
Introduction
With a newer drug development in chemotherapy in last twenty years has led to better survival and life expectancy of patients with cancer. At the same time, the adverse effects of the drugs are dreadful. Early recognition of these effects can prevent the associated pathologies. Cardiac side effects can be monitored using several tolls such as Electrocardiogram, Echocardiography, Coronary angiography, Ventriculography and cardiac MRI [1]. These techniques help in identification of subclinical heart damage [2]. Cardiac biomarkers such as BNP and NT pro BNP and ECG help in identification before clinical symptoms of heart failure, chronic coronary syndrome or myocardial infarction. Moreover, the symptoms if correlated within time span helps in prevention of cardiotoxicities.
The purpose of this search is to review in detail, the association of chemotherapeutic drugs with ECG changes. Also, studies have shown that ECG is the simplest form of examination that can be quickly performed within a duration of 3 minutes and provides the detailed information on cardiotoxicities. Some of the changes that can be noticed; for example, broad P wave lasting for more than 120 ms, QT prolongation with interval of >500 ms. Also, presence of multiple atrial ectopic beats post cessation of chemotherapy [3].
Moreover, ECG recording is just not confined with hospitalization, there are ECG portable monitor with single or two lead are also available for monitoring at home. Nowadays electronic media usage, devices, smart watch smart phones, Holter ECG for 24 hours are also gave for an indication of cardiovascular manifestation. Hence forth, there is a need to carry on ECG before starting chemotherapy, to get a suitable baseline recording that can be related to post treatment measurements.
ECG changes with different chemotherapeutic drugs
Anthracyclines:
Used for the treatment of leukemias, Lymphomas, breast cancer and solid tumors in pediatric population. Doxorubicin persists an effect on development of dilated cardiomyopathy which is irreversible. Also, incidence of 5-8% is observed with daunorubicin combination of 450 mg/m2 [4].
In a study 48 hours of monitoring of patients with Holter ECG, immediately infused doxorubicin infusion had shown paroxysmal fibrillation of atria at a rate of 0.3% [5]. Monitoring of ECG at each visit has shown 6% incidence of this arrythmia with the continuation of chemotherapy [6].
Detection rate of 56.6 % with cardiac dysfunction had an integrated implantable defibrillator. Also, 73.9
Conclusion
Chemotherapeutic drugs are improving life expectancy functional status and quality of life in cancer survivors. But the newer development is leading to profound cardio toxicities. Therefore, it is a need that in clinical practice, ECG monitoring which takes 3 minutes should be carried out at baseline, post phase of treatment. Moreover, whenever any cardiovascular manifestation or symptoms are noticed these non- invasive diagnostics should be performed and monitored regularly to avoid dreadful adverse effects on the cardiac function.
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