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What Are the Risks of Intravenous Iron? |
In general, intravenous iron is safe. |
There is a very small chance of an allergic reaction with the iron infusion. While you are receiving the iron infusion, you will be monitored closely for any signs of an allergic reaction. If you have been prescribed iron and have previously had an allergic reaction to any form of iron, you should tell your doctor immediately. While you are receiving the infusion, if you develop signs of an allergic reaction (like feeling dizzy, swelling of your face, difficulty breathing), you should tell your nurse or doctor immediately. |
If you have any other questions, speak to your doctor, nurse, or pharmacist. |
What Happens Next? |
If you are prescribed intravenous iron, an appointment will be made for you to come in and receive the infusion. The treatment takes several hours, so plan to be in hospital for at least half a day. |
One month after the iron treatment, your doctor will recheck the iron levels in your body and may consider another treatment. |
STATINS |
Statins have been shown to stabilize heart function and prevent hospitalizations from heart failure. Patients with cardiotoxicity may be prescribed statins during their cancer treatment and beyond. |
Common statins |
Rosuvastatin (Crestor) |
Atorvastatin (Lipitor) |
Pravastatin (Pravachol) |
Simvastatin (Zocor) |
Fluvastatin (Lescol) |
How do statins work? |
Statins are given to help control cholesterol, particularly bad cholesterol (LDL). They work by stabilizing and drawing out cholesterol from plaques found in the walls of arteries. Plaque and cholesterol build-up can decrease blood flow in arteries, increasing the risk for CAD and strokes. |
Who should take statins? |
People with high cholesterol levels despite decreasing high fat diets and smoking and increasing physical activity |
People with diabetes |
Those with CAD found on a CT scan |
Patients with cardiotoxicity, during their cancer treatment and beyond |
Most Common Side Effects Include: |
Muscle pain/injury (less than 5%) |
Liver injury |
Gastrointestinal side effects (nausea, constipation) |
Dizziness |
Sleep difficulties |
Headaches |
What do I need to know when taking this medicine: |
It may take many weeks for these medicines to take full effect. |
Don’t eat grapefruit or drink grapefruit juice while taking a statin medicine (except for Fluvastatin, pravastatin or rosuvastatin). Grapefruit can increase the effects the medicine has in your body and increase the chance of side effects. |
Don’t change the dose or stop taking this medicine without talking to your doctor or pharmacist, even if you feel well. |
Don’t drink more than one to two alcoholic drinks per day when taking this medicine. It can increase the risk of side effects on your liver. |
Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. This medicine can harm your baby if you take it during pregnancy. |
To check how the medicine is affecting your body, you will need to visit your doctor regularly. |
CALCIUM CHANNEL BLOCKERS |
Calcium channel blockers relax and open up (dilate) the blood vessels/arteries. This helps improves blood flow to areas of the heart, as well as decrease blood pressure. Common calcium channel blockers include amlodipine (norvasc), nifedipine, and diltiazem. |
DEVICE THERAPIES |
Device Therapies are specialized pacemakers that either make your heart pump more efficiently or protect you from life threatening arrhythmias (abnormal heart rhythms). Deciding on whether a device is right for you – and selecting a device – depends on several factors, such as severity of your symptoms and heart function (as measured by the ejection fraction). |
Three common devices for people with heart failure are: |
Implantable Cardioverter-Defibrillator (ICD) |
Cardiac Resynchronization Therapy (CRT) |
Left Ventricular Assist Devices (LVAD) |
IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR (ICD) |
Patients with heart failure are at risk of arrhythmias, causing the heart to beat too quickly (tachycardia), too slowly (bradycardia), or with an irregular pattern. |
When too fast rhythms originate from the bottom heart chambers (the ventricles), they may cause a patient to feel unwell, pass out, or even die suddenly. These abnormal ventricular arrhythmias are called Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF). |
What Is An ICD? |
Implantable Cardioverter-Defibrillators (ICDs) are specialized pacemakers. They are composed of a thin metal box that contains a battery, electric circuitry, and a wire that is implanted through a vein and sits in the right ventricle. The wire that sits in the right ventricle continuously monitors the heart rate. If the heart rate drops too low, it will pace the heart. If it detects an abnormally fast heart rate, it will either try to pace the heart back into a normal rhythm or deliver a shock to reset the heart to a normal rhythm. |
While ICDs may prevent you from passing out or dying suddenly from ventricular arrhythmia, they do not affect your heart failure symptoms and will not necessarily make you feel better on a day-to-day basis. |
When are ICDs required? |
If you have had a ventricular arrhythmia that made you feel unwell or pass out, you may be a candidate for an ICD. Sometimes ICDs are implanted before a patient develops symptoms related to ventricular arrhythmia. These are called primary prophylactic ICDs. |
The decision to implant an ICD depends on how impaired your heart function is (measured by your ejection fraction) as well as how symptomatic you are. Your health care provider will discuss whether an ICD is a good option with you. |
ICDs may also be used for people with genetic cardiomyopathies who may be at higher risk of developing life-threatening arrhythmias (e.g., Hypertrophic Cardiomyopathy (HCM), Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). |
What are the different types of ICDs? |
ICDs vary depending on the number of leads (wires) implanted in the heart. The simplest is a single chamber ICD, with just one wire sitting in the right ventricle. |
Dual chamber ICDs have a second lead implanted in the right atrium. |
How big is an ICD? |
Current ICDs are about 2 inches by 2 inches (5cm by 5cm) and about half an inch (11mm) thick. They weigh about 1-3 ounces (28-85 grams). |
As technology continues to improve, devices continue to get smaller. |
How are ICDs implanted? |
ICD implantation is usually day-surgery, typically implanted in the Electrophysiology Laboratory. Patients are usually awake during the procedure, and intravenous medication is given to help you relax. With this medication, you will feel drowsy, but will be awake and able to answer questions. |
Most ICDs are implanted using the transvenous (through the vein) approach. A freezing solution is injected under the collarbone, and a small incision is made. The wire (or wires) is then inserted through the incision into a vein and directed to the heart using X-ray guidance. The tip of the wire is attached to the heart muscle, and the other end is hooked up to the pulse generator. The generator is then implanted under the skin just under the collarbone. The procedure usually takes between two and four hours. |
After your ICD implantation, you will be given information about your specific device. You will also receive an appointment in the Pacemaker/Defibrillator Follow-up Clinic for ongoing monitoring. |
What are the risks of an ICD? |
In general, ICD implantation is safe. However, as with any invasive procedure, there are risks. The doctor who is performing the procedure will talk to you more about the risks and ask you to sign a consent form to go ahead with the procedure. |
The risks of ICD implantation include bleeding, infection, puncture of the lung requiring a chest tube, and damage to the heart or to a blood vessel. Overall, the risk of having any of these complications is about 2-3%. The risk of dying from an ICD implantation procedure is very low (well under 1%). |
In the long-term, there is also a risk of having an inappropriate shock, when the ICD delivers a shock not in response to a life-threatening arrhythmia. Receiving a shock from an ICD can be painful and unpleasant, especially if the shock was for the wrong reason. The technology is continuously improving and the risk of receiving an inappropriate shock is decreasing, but it is still an issue to consider with your care team. |
What to do if you get a shock? |
Receiving a shock from your ICD can be painful and upsetting. If you experience a shock, for your safety and for the safety of others, do not drive. If you are standing, move to a seated position. |
If you experience just one shock, do not pass out, and otherwise feel well, you do not need to call 911 or go to the Emergency Department. Call the Device Clinic the same day (or the next business day) to report that you have received a shock. They will likely make an appointment for you to come in to have your ICD interrogated. |
You should go to the Emergency Department if: |
You lose consciousness |
Experience more than one shock in one day, or more than one shock in one minute |
Experience chest pain, shortness of breath, or lightheadedness. |
CARDIAC RESYNCHRONIZATION THERAPY (CRT) |
Cardiac Resynchronization Therapy (CRT), also called a Biventricular Pacemaker, is a specialized pacemaker that works by making the two pumping chambers of the heart (the right and the left ventricle) pump at the same time. The goal of this specialized pacemaker is to make the pumping function of your left ventricle more effective, to improve your symptoms, and make you live longer. |
The main pumping chamber of the heart is the left ventricle, which pumps blood to the body. The other pumping chamber is the right ventricle, which pumps blood to the lungs. In the normal heart, these two chambers pump at the same time. |
In some patients with heart failure, the left ventricle does not pump at the same time as the right ventricle. The muscle walls of the left ventricle can also squeeze in an uncoordinated or ‘dyssynchronous’ fashion. There may be clues on your EKG or ECHO that your ventricles are not coordinated. A CRT device may be recommended to “resynchronize” the ventricles. |
All CRT devices are pacemakers. If you are also a candidate for an ICD, your health care provider may recommend that you receive a combination CRT and ICD device, called a CRT-D device. |
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