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Narrative Literature Review of Cancer Therapy-related Cardiac Dysfunction.

Cancer therapy-related cardiac dysfunction (CTRCD) presents a significant challenge for both oncology and cardiology, necessitating a compre … ion, global longitudinal strain, and diastolic dysfunction are all predictive of the development of cardiotoxicity. Moreover, continuous surveillance of cardiac function throughout the course of cancer therapy is also paramount. A multimodal diagnostic approach, including cardiac biomarkers, echocardiography, cardiac magnetic resonance imaging, and computed tomo …

Therapy-naïve malignancy causes cardiovascular disease: a state-of-the-art cardio-oncology perspective.

Cardiovascular disease (CVD) and cancer are the leading causes of mortality worldwide. Although generally thought of as distinct diseases, the intersectional overlap between CVD and cancer is increasingly evident in both causal and mechanistic relationships. The field of cardio-oncology is largely focused on the cardiotoxic effects of cancer therapies (e.g., chemotherapy, radiation). Furthermore, the cumulative effects of cardiotoxic therapy exposure and the prevalence of CVD risk factors in patients with cancer lead to long-term morbidity and poor quality of life in this patient population, e

Established and Emerging Cancer Therapies and Cardiovascular System: Focus on Hypertension-Mechanisms and Mitigation.

Cardiovascular disease and cancer are 2 of the leading causes of death worldwide. Although improvements in outcomes have been noted for both disease entities, the success of cancer therapies has come at the cost of at times very impactful adverse events such as cardiovascular events. Hypertension has been noted as both, a side effect as well as a risk factor for the cardiotoxicity of cancer therapies. Some of these dynamics are in keeping with the role of hypertension as a cardiovascular risk factor not only for heart failure, but also for the development of coronary and cerebrovascular diseas…

Cardio-oncology: Understanding the different mechanisms of cardiovascular toxicity.

Due to the success of finding treatments for various types of cancer, overall cancer survival has increased substantially in recent decades. … nt. All anatomical structures of the heart can, however, be affected by transthoracic radiotherapy. Cardiotoxicity mechanisms are recognized according to the presence or absence of structural anomalies and their reversibility, being classified into Type I and Type II, aiming to distinguish the drugs that induce irreversible damage (Type I) from the drugs that pr …

Interferon-gamma induces chronic active myocarditis and cardiomyopathy in transgenic mice.

Chronic heart failure is associated with an activation of the immune system characterized among other factors by the cardiac synthesis and s … lar dilation and impaired systolic function induced by IFN-gamma overexpression. IFN-gamma-mediated cardiotoxicity was associated with high-level cardiac transcription of the proinflammatory cytokines tumor necrosis factor-alpha and interleukin-12 and the macrophage-attracting chemokines MCP1 and MIP1-alpha. Myotoxic IFN-gamma effects could not be detected in sm …

Carfilzomib in multiple myeloma: unraveling cardiac toxicities - from mechanisms to diagnosis and management.

The survival rates of patients with hematological malignancies such as multiple myeloma have improved with advances in cancer treatment. How … on CFZ, details its applications in treating multiple myeloma, presents its potential mechanisms of cardiotoxicity and the incidence of cardiotoxic events, and provides recommendations for the evaluation and management of adverse cardiac events during the early treatment of patients with this drug.

Podophyllotoxin via SIRT1/PPAR /NF-κB axis induced cardiac injury in rats based on the toxicological evidence chain (TEC) concept.

BACKGROUND: The study of cardiotoxicity of drugs has become an important part of clinical safety evaluation of drugs. It is commonly known that podophyllotoxin (PPT) and its many derivatives and congeners are broad-spectrum pharmacologically active substances. Clinical cardiotoxicity of PPT and its derivatives has been raised, basic research on the mechanism of cardiotoxicity remains insufficient. PURPOSE: In present study, our group's innovative concept of toxicological evidence chain (TEC) was applied to reveal the cardiac toxicity mechanism of PPT by targeted metabolomics, TMT-based quanti…

Doxorubicin and paclitaxel (sequential combination) in the treatment of advanced breast cancer.

Based on preclinical data, we designed a phase I/II clinical trial to determine the efficacy and toxicity of doxorubicin followed by paclita … se. In the 128 cycles assessable for toxicity, there were no relevant clinical signs or symptoms of cardiotoxicity. This absence of significant cardiotoxicity required confirmation in a phase II trial. Since a maximum tolerated dose of paclitaxel had not been reached during the first study and an increasing risk of neutropenia and peripheral neurotoxicity was fe …

Management of primary central nervous system lymphoma and coexisting heart failure with reduced ejection fraction: a narrative review.

BACKGROUND: Patients with primary central nervous system lymphoma (PCNSL) often require high-dose methotrexate (HD-MTX)-based regimens for effective disease control. However, the coexistence of heart failure with a reduced ejection fraction (HFrEF) poses significant challenges due to the increased risk of treatment-related cardiotoxicity and the potential exacerbation of cardiac dysfunction from fluid overload. MAIN BODY: This review explores current PCNSL treatment modalities and their implications for patients with HFrEF. These findings emphasize the importance of multidisciplinary care, th…

[Takotsubo and surroundings. Step by step postpartum stress-induced cardiomyopathy shows its facet. A peculiar case of atypical takotasubo in the peripartum period].

Takotsubo syndrome is an acquired cardiomyopathy with transient and reversible left ventricular dysfunction that can mimic an acute coronary … motional or physical stress triggers may induce microvascular dysfunction and catecholamine-induced cardiotoxicity due to cyclic AMP-mediated calcium overload. We report our experience highlighting the possible pathophysiological and clinical overlap of emotional-triggered catecholamine cardiotoxicity, arterial hypertension and physiological cardiovascular overl …

Rapid tranquillisation: time for a reappraisal of options for parenteral therapy.

BACKGROUND: When parenteral treatments are indicated for acutely disturbed behaviour, previous guidelines have recommended droperidol or haloperidol in combination with benzodiazepines. However, there has been recent concern over cardiotoxicity and sudden death associated with some antipsychotic medication and droperidol has now been withdrawn. AIMS: To ascertain what alternatives can be recommended to replace intramuscular droperidol. METHOD: Selective review of current guidelines and the literature pertaining to rapid parenteral tranquillisation. RESULTS: Current guidelines recommend halo…

A case of successful resuscitation from hypokalemic cardiac arrest using rapid intravenous potassium.

A 31-year-old male with no prior comorbidities presented with rapid-onset quadriparesis following one week of non-bloody diarrhea. Initial evaluation revealed severe hypokalemia (1.41 mmol/L) and an electrocardiogram (ECG) demonstrating signs of cardiotoxicity (irregular rhythm, diffuse ST depression, prominent U waves, and prolonged QT interval). The patient subsequently experienced cardiac arrest due to polymorphic ventricular tachycardia (VT). VT was refractory to an initial 200 J DC shock but terminated following the rapid intravenous administration of a 40 mEq potassium chloride (KCl) bol…

Sodium Channel-Mediated Ventricular Arrhythmia After Delphinium denudatum Ingestion Managed Conservatively in a Resource-Limited Setting.

BACKGROUND: Delphinium denudatum (jadwār) is a traditional South Asian herbal root containing aconitine-like alkaloids that cause sodium channel-mediated cardiotoxicity. Human toxicity data remain limited, particularly from resource-limited settings. CASE SUMMARY: A man in his late 20s presented 6 hours after accidental ingestion of Ddenudatum root with palpitations and autonomic symptoms. Continuous electrocardiographic monitoring revealed frequent ventricular ectopy with nonsustained polymorphic ventricular tachycardia. He was treated with intravenous lidocaine and magnesium sulfate, result…

Cardiometabolic disease and cardio-oncology: Insights from iPSC models and tissue engineering.

Heart disease and cancer share common risk factors, genetic predispositions, and metabolic and inflammatory components. Metabolic reprogramming can drive disease progression in both, with cardiometabolic syndrome-marked by obesity, insulin resistance, dyslipidemia, and hypertension-contributing to cancer development. Studies link around 20% of cancer cases to obesity, while elevated glucose and triglyceride levels increase the risk of liver, thyroid, and respiratory cancers. Beyond treatment-related cardiotoxicity, cancer patients often have pre-existing cardiovascular disease (CVD) at diagnos…

Pericardial Calcification Following Acute Myopericarditis After Initial CHOP Treatment for Mantle Cell Lymphoma: A Case Report.

A 56-year-old woman with B-cell lymphoma underwent chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP). Within 30 hours, the patient developed acute cardiotoxicity, characterized by elevated cardiac enzymes and ST-segment and T-wave (ST-T) changes on electrocardiogram (ECG), despite normal echocardiographic findings. Both ST elevations and enzyme levels spontaneously improved the following day. One week later, computed tomography (CT) revealed a newly developed high-density area on the pericardium, suggestive of early calcific deposition, which was confirmed t…

Loperamide Toxicity Revealing Apical Hypertrophic Cardiomyopathy.

Loperamide, a μ-opioid receptor agonist, can cause cardiotoxicity by inhibiting the potassium ion channel and slowing cardiomyocyte repolarization. This, in turn, can lead to frequent early afterdepolarizations, the most common mechanism of drug-induced long QT syndrome and torsades de pointes. Apical hypertrophic cardiomyopathy (AHCM) is a nonobstructive hypertrophic cardiomyopathy rarely associated with malignant arrhythmias. We present a case of loperamide-induced malignant ventricular arrhythmia revealing underlying AHCM in a 25-year-old woman with a history of sudden cardiac arrest (SCA) …

Heart transplantation in survivors of childhood cancer.

There are approximately 450,000 survivors of childhood cancer due, in large part, to successes of therapeutic regimens. With this success comes an increase in the number of patients developing cardiotoxicity as a result of cancer therapies. In certain cases, this includes heart failure recalcitrant to medical therapy, and consideration for heart transplantation may be necessary. However, this group of patients has unique comorbidities that may affect outcomes. Despite this, available data show that complications and overall survival are similar for patients transplanted for anthracycline-induc…

Cardio-oncology: cardiovascular complications of cancer therapy.

This paper focuses on three classes of commonly used anticancer drugs, which can cause cardiotoxicity: anthracyclines, monoclonal antibodies exemplified by trastuzumab and tyrosine kinase inhibitors. Anthracyclines can induce cardiomyocyte necrosis and fibrosis. Trastuzumab can cause cardiac stunning. The tyrosine kinase inhibitors can increase systemic arterial pressure and impair myocyte contractility. In addition, radiation therapy to the mediastinum or left chest can exacerbate the cardiotoxicity of these anticancer drugs and can also cause accelerated atherosclerosis, myocardial infarctio…

A case report of fludarabine associated ectopic atrial bradycardia and literature review of fludarabine induced bradycardia.

BACKGROUND: Fludarabine is a chemotherapeutic agent with lymphodepleting effects that is increasingly used as part of a conditioning regimen prior to allogeneic stem cell transplantation. Fludarabine is generally considered a relatively safe medication with only rare cases of cardiotoxic side effects. CASE PRESENTATION: Here, we present a case of a 30-year-old woman who was undergoing conditioning for a haploidentical cell transplantation for treatment of Fanconi anemia with a 5-day course of daily fludarabine infusion. After her second fludarabine infusion, she was noted to have ectopic atri

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… Although, cardiotoxicity associated with chemotherapeutic agents such as anthracyclines, 5-fluorouracil, and taxanes is well-documented in the literature, fludarabine is considered relatively safe in respect to its effects on the cardiovascular system, with limited number of case reports documenting … Chemotherapy-induced Cardiotoxicity. Maedica (Bucur). 2013;8(1):59–67. 6. Ritchie DS, Seymour JF, Roberts AW, Szer J, Grigg AP. Acute left ventricular failure following melphalan and fludarabine conditioning. Bone Marrow Transplant. 2001;28(1):101–3. 10.1038/sj.bmt.1703098 7. …

Cardioprotection in the Modern Era of Cancer Chemotherapy.

The current arsenal of cancer chemotherapy is broad and rapidly expanding and includes conventional cytotoxic agents and targeted and immune … proaches to cardioprotection. In this review, we describe antitumor agents commonly associated with cardiotoxicity, with a focus on risk assessment, surveillance strategies, and pharmacologic and nonpharmacologic interventions aimed at preventing and mitigating chemotherapy-induced myocardial dysfunction.