Chapter 23: Administration of systemic anticancer therapies
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Cardiotoxicity
The effects of cardiotoxicity can be acute or chronic. Acute effects usually manifest as transient electrocardiogram changes, resolve without serious complications and occur in 10% of patients receiving chemotherapy; chronic effects manifest weeks or months following chemotherapy and manifest as non‐reversible cardiomyopathy (Camp‐Sorrell [27]). Chronic effects present as biventricular congestive heart failure with symptoms such as dyspnoea, non‐productive cough and pedal oedema (Camp‐Sorrell [27]). These symptoms tend to gradually deteriorate and are associated with a 60% mortality (Camp‐Sorrell [27]).
Anthracyclines cause chronic cardiotoxicity by damaging the cardiac myocyte cells and cumulative doses should not exceed what is referred to as a ‘lifetime dose’. The risk of acute and chronic cardiotoxicity of anthracyclines is increased in patients with pre‐existing cardiac disease, hypertension, mediastinal radiation or exposure to other cardiotoxic agents (Camp‐Sorrell [27]). Chemoprotectants such as dexrazoxane can be used as they have the ability to protect cardiac tissue by blocking damage to myocytes (Camp‐Sorrell [27]).
