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Your dose of immunosuppression medications will change over time. The biggest dose is usually taken right after your transplant and decreased over time. Because one of the side effects of taking immunosuppression is infection, you will also likely be prescribed medication(s) to prevent infection. While you are in the hospital, you will be taught all about your medications. |
Learn more in the After the Surgery: Living with a Transplanted Heart (Heart Transplant Recipient and Caregiver Manual Book 3) |
CARDIAC REHABILITATION |
Rehabilitation after a cardiac incident helps people with heart disease improve their cardiac health and fitness. It also helps them reduce their chance of future incidents through lasting lifestyle and behaviour changes. |
UHN’s Cardiovascular Rehabilitation Program helps you: |
Take charge of your medical condition |
Develop strategies to improve your risk factors for cardiovascular disease |
Maintain an exercise program to improve your health and well being |
Incorporate healthy food choices and practices to manage your health and well being |
Develop strategies to manage your psychosocial risks for cardiovascular disease. |
Cardiac College was developed specifically to help guide patients in developing positive and healthy behaviour to live and thrive with cardiovascular disease. Patients will learn skills to: |
Build a foundation for a safe heart |
Develop skills to take care of your heart |
Prepare for life after rehab |
Learn more information about UHN’s cardiac rehab program. |
HOW IS HEART FAILURE MANAGED? |
Heart failure treatments can help people with heart failure live longer, feel better, and avoid being admitted to hospital. Different treatments and approaches to managing heart failure work in combination, and require participation from patients, caregivers, and the health care team. |
Typically, a combination of lifestyle changes and medications is required. Surgical procedures may also be considered as part of the treatment plan. |
A healthy lifestyle is essential. For someone with heart failure, this means paying extra attention to diet, getting regular exercise, avoiding alcohol, and taking care of your mental well-being. These behaviours can help with symptoms and have a positive influence on your heart condition. |
Depending on the severity, the cause, and the type of heart failure at the time of diagnosis, medications are typically prescribed and adjusted over many follow-up visits. |
Heart failure medications work in different ways. They may strengthen the heart’s pumping function, reduce the amount of work that the heart has to do or help manage symptoms. |
Surgical procedures may be necessary to implant a device or help the heart function better in people with heart failure. |
Devices such as a defibrillator or a pacemaker help correct harmful heart rhythms or lack of synchronicity of heart rhythm in the right and left sides of the heart. |
An artificial heart pump called a left ventricular assist device or LVAD may be needed for someone with advanced heart failure. In end-stage heart failure, transplantation of a new heart may be necessary. |
It is often difficulty to predict how an individual responds to different heart failure therapies. Some patients improve dramatically, others remain stable over time, and some can progress more rapidly with worsening heart failure. |
Treatments are recommended by the care team based upon a number of clinical factors and in partnership with the patient. |
IMMUNE THERAPY |
The immune system works by recognizing foreign ‘outsider’ cells and boosting the body’s defense system (antibodies) to attack them, preventing damage to the body. |
Immune responses attack any foreign invader, such as bacteria, viruses, or cancer cells. The immune system can also produce cytokines, which are substances that act as messengers; cytokines tell the body’s cells to attack foreign cells. |
IMMUNE CHECKPOINT INHIBITORS |
Cancer cells can be difficult to recognize in the early stages, as they start off as normal cells – the body may not initially recognize them as foreign. Immune checkpoint inhibitors (ICIs) are a type of immune therapy that strengthens the body’s immune system to recognize and fight cancer cells. |
Common cancers treated with ICIs include: |
Certain types of lymphoma |
Skin cancer |
Lung |
Kidney |
Bladder |
Gynecologic |
Common ICI medications include: |
Atezolizumab |
Avelumab |
Durvalumab |
Ipilimumab |
Nivolumab |
Pembrolizumab |
MYOCARDITIS |
A possible side effect of ICI therapy is organ inflammation, including myocarditis (inflammation of the heart muscle). |
The main symptoms of myocarditis include chest pain, fatigue, fast or abnormal heart rates, shortness of breath, swelling in the feet and ankles, joint and muscle pain, and fevers. Although myocarditis can occur at any time, it is more likely to occur early into ICI therapy, usually within the first 2-3 months of treatment. |
Diagnostic tests for myocarditis include: |
ECG |
Chest Xray |
Cardiac MRI (can show signs of inflammation, and pumping function of heart) |
Echocardiogram (can show pumping function of heart, as well as fluid around the heart) |
Blood tests (looking for inflammation; CRP, and injury to heart muscle- troponin/BNP) |
Cardiac biopsy (small sample of heart muscle removed for checking for inflammation) |
Myocarditis may be treated by: |
High dose steroids by IV in hospital followed by a transition to oral steroids, such as prednisone, and tapering over time until symptoms are resolved and there is normal heart function |
Postponing ICI therapy |
Pain medications such as Tylenol and non-inflammatory medications (ibuprofen) |
LIVING WITH CARDIOTOXICITY |
The goal of a cardio-oncology program is to help prevent short- and long-term cardiac complications of cancer therapy. As a result, your team works closely with you and other specialists to ensure that your heart is safe prior to, during, and following your cancer therapies. |
Part of living with cardiotoxicity is being aware of its symptoms. Being aware of the heart-related symptoms helps you monitor your well-being and bring changes to the attention of your healthcare team. |
TAKING CARE OF RISK FACTORS FOR CARDIOTOXICITY |
It is important to work closely with your cardio-oncology team to identify and treat cardiac complications resulting from cancer therapy. Preventing and treating these cardiac complications during cancer therapy (and beyond) helps to prevent a “second hit” to the heart. Controlling blood pressure, blood sugars, cholesterol levels and maintaining a healthy weight and exercise levels helps prevent further injury to the heart later in life. |
Blood Pressure |
To prevent cardiotoxicity both now and into the future, it is important to ensure that other risk factors for heart disease are treated during your cancer treatment, and beyond. This includes maintaining a healthy blood pressure. |
Diet and Exercise |
Part of blood pressure control includes diet and exercise. |
Physical Activity |
We encourage people to continue to be physically active during their cancer treatment. Exercise has many physical and psychological benefits, and may help alleviate some cancer treatment symptoms, leading to improved appetite; sleep; and energy levels; increased strength; lower stress and anxiety; and better control of diabetes, high cholesterol, and high blood pressure. |
The long-term goal of exercise is 90-150 minutes per week of moderate physical activity. This can be achieved by a brisk walk, jogging, cycling, and/or swimming. If you are not physically active now, you can start by walking briskly for 10-15 minutes 2-3 times per week and gradually working your way up to 30 minutes five times per week. It is also important to have a warm-up and cool-down period of five minutes each during your exercise. |
If you have questions about exercise, please ask your healthcare team. Cardiac rehabilitation programs are an excellent way of increasing physical activity during your cancer treatments, and beyond. |
Note that there are times when you are not recommended to exercise. |
Avoiding Alcohol and Smoking |
Avoiding alcohol is important when managing or decreasing your risk of cardiotoxicity. Alcohol is a toxin to the heart and can lead to heart failure. |
Smoking is another important risk factor for heart disease. It is important that you quit smoking to prevent high blood pressure, coronary disease, and stroke. Reach out to your healthcare team if you need help to quit smoking. |
Managing Stress |
Stress is common while undergoing cancer therapy and having a heart problem on top of cancer treatment can further increase stress levels. Managing stress is important, as increased stress can elevate blood pressure levels and make daily activities more difficult. It is important to reach out to your support persons and healthcare team if you are having increased stress or anxiety levels. |
MEDICATION MANAGEMENT |
People with more complex medical needs, like heart failure, may require multiple medications throughout the day. |
To ensure the safe, consistent, and effective use of medications, it is important to have a system in place. |
Proper medication management has numerous advantages for patients, caregivers, and healthcare providers: |
It reduces medication errors. Medication errors, such as improper timing or dosing, can result in unpleasant or dangerous side effects, make the medication ineffective, or even result in death. |
It helps achieve the best possible outcome. When medications are managed properly, your response to the dosage is carefully monitored. This means that if your health suddenly deteriorates or you stop responding in the same way, the prescription or dosage can be accurately adjusted to correct the situation. |
It provides peace of mind. Many people, particularly the elderly, may have difficulty remembering to take medications on time. Having a system helps assure everyone involved that you are receiving the right medication at the right time. |
TIPS FOR MANAGING YOUR MEDICATIONS |
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