Trastuzumab and Cardiotoxicity

Evasão na educação a distância: pontos e contrapontos à problemática

“…Além das causas relacionadas às falhas na comunicação, por meio das tecnologias digitais e da própria ausência de uma alfabetização, letramento e inclusão tecnológica, também aparecem como causas a questão financeira e emocional (FIUZA, 2012). Tudo indica que estudar exige dedicação, equilíbrio para se manter em movimento nas pesquisas e metodologias ativas à elaboração coletiva, bem como acolhimento e preparo por parte da instituição quanto aos seus profissionais, para que os estudantes tenham o suporte técnico-pedagógico necessário para o processo formativo e à globalidade humana (UMEKAWA, 2014;NASCIMENTO, 2016).…”

Cardiotoxicity of Non Cardiovascular Drugs: A Mechanistic Point of View

“…According to the National Cancer Institute, cardiotoxicity means the toxicity that affects the heart 7 . The Cardiac Review and Evaluation Committee which supervised the Trastuzumab trial put forward certain constellation of criteria which would indicate the chemotherapy induced cardiotoxicity in terms of one or more of 1) Cardiomyopathy, either global or sepal, 2) Heart failure, 3) Signs associated with heart failure as S3 gallop, tachycardia, edema, 4) Decline in left ventricular ejection fraction (LVEF) of at least 5% to less than 55% with sign symptoms of heart failure or asymptomatic decrease in LVEF of at least 10% to less than 55% 8 . The cardiac events associated with various clinical drugs may range from mild transient increase in blood pressure or ECG changes or to more severe conditions like arrhythmia, pericarditis, myocarditis, myocardial infarction and result in left ventricular dysfunction and congestive heart failure 9 .…”

“…Based on the time to event, the cardiac events might be acute or sub acute which occur within two weeks and characterized by arrhythmia, pericarditis, myocarditis, acute heart failure or acute coronary syndromes and detected through ECG changes 6,8 . The chronic and more toxic effects may be classified into early toxicity occurring within 1 year of termination of the chemotherapeutics or late toxicity occurring after one year of the termination of the drug and range between asymptomatic systolic or diastolic dysfunction to left ventricular dysfunction to severe congestive Cardiomyopathy, heart failure and even death 6,8 .…”

“…The factors promoting the development of cardiotoxicity can be drug related or individual risk factors. The drug factors might include drug overdose, narrow therapeutic window, drug interactions, inappropriate time or mode of administration, pre treatment with cardiotoxic drugs, idiosyncrasy, defective metabolism and excretion of the drug and so on 6,8 . The individual factors include extremes of age, female gender, BMI, smoking, race, underlying heart disease, hepatic and renal impairment, low cardiac ejection fraction, genetic factors etc 10 .…”

“…The cardiac dysfunction due to direct cardiotoxicity are of two types as -type 1 cardiac dysfunction is predominantly due to oxidative stress resulting in mitochondrial dysfunction, uncoupling of oxidative phosphorylation, increased mitochondrial permeability and inhibition of the metabolic pathways and type 2 cardiac dysfunction is associated with the ErbB2 pathway 8 . There is a fine line of regulation between apoptotic pathways (oxidative stress) and survival pathways (HER-ErB) and an unregulated toxic apoptotic pathway coupled with inhibition of the survival pathway may result in various stages of cardiotoxicity 11 .…”