Patofisiologi dan Tata Laksana Kardiotoksisitas yang Diinduksi Kemoterapi
DOI:
https://doi.org/10.56951/3hzabj15Kata Kunci:
kardiotoksisitas, kanker, kemoterapiAbstrak
Menurut European Society of Cardiology (ESC), kardiotoksisitas didefinisikan sebagai kerusakan fungsi maupun struktur organ jantung yang berhubungan dengan paparan obat, terutama terapi antikanker seperti kemoterapi dan radioterapi, maupun akibat dari kanker itu sendiri. Secara umum, kardiotoksisitas yang diinduksi kemoterapi diklasifikasikan ke dalam lima jenis, dengan dua tipe utama yang paling sering dikaitkan dengan terapi antineoplastik berisiko tinggi. Mekanisme kardiotoksisitas yang diinduksi kemoterapi dapat terjadi baik secara langsung maupun tidak langsung, dengan faktor
yang berperan antara lain: dosis kumulatif, sediaan obat, formulasi, serta metode penghantaran obat. Penatalaksanaan kardiotoksisitas bergantung pada jenis gangguan kardiovaskular yang dialami oleh pasien. Pada kondisi hipertensi, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), atau calcium channel blockers golongan dihydropyridine merupakan pilihan terapi yang direkomendasikan. Terapi antikanker masih dapat dilanjutkan selama interval QT ≤500 ms dan perubahan interval QT <60 ms, serta tidak ditemukan aritmia ventrikel maupun
sinkop. Untuk penanganan fibrilasi atrium, didasarkan pada pertimbangan utama, yaitu kontrol irama dan kontrol laju, serta profilaksis tromboemboli. Pencegahan kardiotoksisitas dimulai dengan penilaian risiko kardiovaskular dan faktor predisposisi secara komprehensif. Pasien dengan banyak faktor risiko, terutama bila kondisi tidak terkontrol dengan baik, dan/atau memiliki penyakit kardiovaskular yang telah ada sebelumnya, memerlukan tata laksana yang sama dengan pasien yang berisiko tinggi.
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