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Breast Cancer, Cardiomyopathy, Tachycardia. Low BP, Lightheadedness. Does ICD Make Sense In My Case?
I am 58 yo female. Following doxorubicin for bc, was Dx d with severe dilated cardiomyopathy (2008) Did fairly well for a few years. Now EF = 20-25. Also sustained tachycardia . CHF No arrythmia Am currently on low dose coreg, lisinopril , florosimide. Coreg being titrated to maximize effectiveness. Blood pressure low Average about 88/60. Experience lightheadedness. Cardiologist urging ICD. Would have to be implanted on Rt side as left side mastectomy leaves little tissue avail. I don t really want the ICD. Do not feel the risks outweigh benefits at this point. Given that my condition will likely worsen Id prefer to die quickly than suffer organ failure, pain and debilitation. Am I too pessimistic? Does ICD make sense in my case
Wed, 10 Oct 2012
Hi there,
Thanks for writing in.
I am a medical specialist with an additional certification in Cardiology.
I will put it this way that with cardiomyopathy diagnosed in 2008, you have done rather well in last over 4 years, further complications (which are not there as you wrote you have no arrhythmia) are expected and ICD is for prevention of sudden cardiac death from arrhythmia. So, if you had only cardiomyopathy not advising you to undergo ICD implantation would be unethical.
Now from this point onward, you ought to have one to one talk with oncologist (who is treating you for ca Breast) if he/she thinks that there is chance of your recovery for which chemotherapy is given then it would be a mistake not to undergo a rather benign procedure ias ICD implantation. Almighty decides how and when we leave. As doctors we do not force such decision like allowing DNR but ICD implantation is a logical decision in a person who has every reason to believe that there is chance of survival with concurrent therapy of ca breast. Therefore, after having talked to your oncologist you take the decision rather than leaving it on anyone else. With Best Wishes. Sincerely Dr Anil Grover
Thanks for writing in.
I am a medical specialist with an additional certification in Cardiology.
I will put it this way that with cardiomyopathy diagnosed in 2008, you have done rather well in last over 4 years, further complications (which are not there as you wrote you have no arrhythmia) are expected and ICD is for prevention of sudden cardiac death from arrhythmia. So, if you had only cardiomyopathy not advising you to undergo ICD implantation would be unethical.
Now from this point onward, you ought to have one to one talk with oncologist (who is treating you for ca Breast) if he/she thinks that there is chance of your recovery for which chemotherapy is given then it would be a mistake not to undergo a rather benign procedure ias ICD implantation. Almighty decides how and when we leave. As doctors we do not force such decision like allowing DNR but ICD implantation is a logical decision in a person who has every reason to believe that there is chance of survival with concurrent therapy of ca breast. Therefore, after having talked to your oncologist you take the decision rather than leaving it on anyone else. With Best Wishes. Sincerely Dr Anil Grover
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