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Introduction Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that target the host's immune negative regulation receptors. These receptors include cytotoxic T-lymphocyte associated protein-4 (CTLA-4), programmed cell death receptor 1 (PD-1), and programmed cell death ligand 1 (PD-L1). At present, there are seven ICI agents that are approved by the U. S. Food & Drug Administration (FDA). These agents include ipilimumab (anti-CTLA-4), nivolumab, pembrolizumab, cemiplimab (anti-PD-1), avelumab, atezolizumab, and durvalumab (anti-PD-L1). ICI use is associated with immune-related adverse events (irAEs). irAEs have been reported to affect different organs and organ systems, including the heart (1). Cardiotoxicities induced by ICI therapy are uncommon. The most frequently seen ICI-related cardiotoxicity is myocarditis, which is an inflammatory condition of the heart muscle cells. Pathologically, myocarditis is defined as histologic evidence of inflammatory infiltrates within the myocardium with or without myocyte degeneration and necrosis of non-ischemic origin (2). Myocarditis is a rare irAE which is reported to have a high mortality rate (1). Timely diagnosis and treatment of myocarditis is essential for efficient management of the condition. Besides myocarditis, other reported cardiotoxicities include cardiomyopathy, conduction defects (heart block), atrial and ventricular arrhythmias, and pericarditis/pericardial effusion (2).
Emergency Medicine Doctors
Emergency Medicine Nurses
Paramedics
Rural GP's
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