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Chemotherapy Cardiotoxicity: Detection and Prevention

Cancer therapy-related cardiac dysfunction across drug classes

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Chemotherapy Cardiotoxicity: Detection and Prevention?

Cardiotoxicity is defined as a decline in left ventricular ejection fraction by more than 10 percent below 53 percent or symptomatic heart failure during or after cancer therapy.

Anthracyclines cause dose-dependent cardiotoxicity with risk increasing above cumulative doses of 250 to 400 mg/m2 of doxorubicin equivalent.

HER2-targeted therapy with trastuzumab, pertuzumab and trastuzumab emtansine cause typically reversible cardiotoxicity, especially when given after anthracyclines.

Tyrosine kinase inhibitors, immune checkpoint inhibitors, fluoropyrimidines, alkylators and radiation therapy contribute additional cardiac risks.

Mechanisms include direct myocyte injury, oxidative stress, mitochondrial dysfunction, immune-mediated inflammation and vascular toxicity.

Symptoms

Asymptomatic decline in left ventricular ejection fraction on surveillance imaging is common.
Dyspnea on exertion progressing to dyspnea at rest with heart failure development.
Lower extremity edema, weight gain and reduced exercise tolerance.
Palpitations, arrhythmias including atrial fibrillation and conduction abnormalities.
Chest pain, ischemic symptoms or signs of pericarditis with specific agents.

Risk Factors

Cumulative anthracycline dose, concurrent or sequential cardiotoxic therapies and radiation to chest.
Pre-existing heart disease, hypertension, diabetes and dyslipidemia.
Older age, female sex for trastuzumab and pediatric or very elderly age for anthracyclines.
Smoking, sedentary lifestyle and elevated baseline biomarkers including troponin and BNP.
Genetic predisposition with polymorphisms affecting drug metabolism and cardiac repair.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • New onset dyspnea, orthopnea, paroxysmal nocturnal dyspnea or peripheral edema during cancer treatment requires evaluation.
  • Significant decline in ejection fraction on surveillance imaging warrants cardio-oncology consultation.
  • Chest pain, palpitations, syncope or new arrhythmias need urgent assessment.
  • Symptomatic heart failure or cardiogenic shock during therapy is a medical emergency.
  • Long-term survivorship monitoring detects late cardiotoxicity occurring years after completion of cancer therapy.

Treatment Methods

01
Risk stratification at baseline includes echocardiography, electrocardiogram, biomarkers and assessment of cardiovascular risk factors.
02
Preventive strategies include dexrazoxane for anthracyclines in high-risk patients, ACE inhibitors and beta-blockers in selected patients and minimizing cumulative dose.
03
Surveillance during therapy with periodic echocardiography, biomarkers and clinical assessment guides early intervention.
04
Heart failure management with guideline-directed medical therapy including ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors.
05
Cardio-oncology multidisciplinary care, treatment modifications based on cardiac status, cardiac rehabilitation and survivorship planning ensure optimal long-term outcomes.

Which Department to Visit?

You can visit our Onkoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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