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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
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A comprehensive nursing assessment is essential for patients with valvular heart disease, which involves any dysfunction of the heart valves that could impact blood flow and overall heart function.Subjective Data Collection:Chief Complaint and Present Illness: Start with the patient's primary concerns, focusing on the onset, duration, and progression of cardiac symptoms such as dyspnea, fatigue, chest pain, and palpitations.Past Medical History: Collect detailed information on any previous...
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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Navigating Complexities: Leadless Pacemaker Management in Proton Therapy for a Pacemaker-Dependent Bilateral Breast

Mohammad Saki1,2, Hardev Grewal1,2, Mark Artz1,2

  • 1Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA.

International Journal of Particle Therapy
|August 6, 2024
PubMed
Summary
This summary is machine-generated.

Replacing a conventional pacemaker with a leadless device enabled a patient with bilateral breast cancer to safely undergo proton therapy. This strategic intervention mitigated risks associated with radiation exposure to cardiac implantable electronic devices (CIEDs).

Keywords:
BreastMicraPacemakerProton therapy

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Area of Science:

  • Oncology
  • Cardiology
  • Medical Physics

Background:

  • Management of pacemaker-dependent patients undergoing radiotherapy presents unique challenges, especially when the device is within the radiation field.
  • Bilateral breast cancer treatment requiring adjuvant radiotherapy necessitates careful consideration of cardiac implantable electronic devices (CIEDs) due to potential radiation-induced malfunction.

Observation:

  • A conventional pacemaker, situated within the radiotherapy target for bilateral breast cancer, posed a significant risk of malfunction.
  • Transposition of the conventional pacemaker was not feasible due to the bilateral nature of the treatment field.

Findings:

  • Replacement with a leadless pacemaker (Micra) successfully mitigated the risk of direct radiation damage and adverse effects of proton therapy on the CIED.
  • The patient completed pencil beam proton therapy without device malfunction, demonstrating the efficacy of leadless pacemakers in such scenarios.
  • Proton therapy with leadless cardiac devices is feasible, though potential neutron production and single-event upsets (SEUs) require ongoing monitoring.

Implications:

  • Strategic device selection and risk assessment are crucial for managing patients with CIEDs undergoing advanced radiotherapy.
  • Leadless pacemakers offer a viable solution for pacemaker-dependent patients requiring radiotherapy in challenging anatomical locations.
  • Further research into neutron production and SEUs in CIEDs during proton therapy is warranted to refine safety protocols.