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Myocardial disease
Cardiac complications and manifestations of chemotherapy for cancer
  1. Muhammed Zeeshan Khawaja1,2,
  2. Catherine Cafferkey3,
  3. Ronak Rajani2,
  4. Simon Redwood1,2,
  5. David Cunningham3
  1. 1Cardiovascular Division, British Heart Foundation Centre of Excellence, The Rayne Institute, King's College London, St Thomas’ Hospital, London, UK
  2. 2Department of Cardiology, Guy's & St Thomas’ NHS Foundation Trust, London, UK
  3. 3Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
  1. Correspondence to Dr Muhammed Zeeshan Khawaja, Cardiovascular Division, British Heart Foundation Centre of Excellence, The Rayne Institute, King's College London, St Thomas’ Hospital, 6th Floor East Wing, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK; Dr.zeeshan.khawaja{at}

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The use of potent chemotherapeutic agents and radiotherapy to target cancer cells has certainly improved outcomes for oncology patients. However, there is increasing recognition of the importance of cardiotoxic side effects of such therapy in both specialties, affecting not just patient survival but also quality of life. Consequently, there is an increasing need for cardiologists to work in close collaboration with oncologists to not only develop methods of predicting patient susceptibility to cardiotoxicity, but also to provide long term follow-up for these patients after the cessation of chemotherapy. The impact of cancer therapy upon cardiac status should be part of the knowledge base for all cardiologists and this new interdisciplinary specialty has become known as cardioncology.

It has been suggested that the effects should be classified as non-reversible (type I) and reversible (type II), with the former associated with ultrastructural changes on myocardial biopsy.1 This distinction is especially important given the potential for cure or prolonged survival for oncology patients after some treatment regimens, in whom such end-organ disease may affect not only the prognosis but also quality of life. Yet the dysfunction caused by ‘type II’ agents is not always reversible, the distinction not always binary, and the clinical presentation is perhaps just as relevant when identifying causative agents and initiating appropriate therapy. As such we have classified the cardiac complications of the effects of the potentially cardiotoxic agents used in the treatment of oncological disease and their presenting syndrome (heart failure (HF), cardiac ischaemia, arrhythmias, and hypertension). We then consider the current approaches to the diagnosis of cardiotoxicity (especially chemotherapy induced cardiomyopathy) and the contemporary evidence and guidance on patient management.

Heart failure


Anthracyclines are among the most commonly used chemotherapeutic agents. Drugs such as doxorubucin and epirubicin are effective in the treatment of both solid tumours such as …

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  • Contributors All authors have contributed to the conception, structure and content of the manuscript. All authors have had final approval of the submitted manuscript.

  • Competing interests In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. DC has served on an advisory board for Roche and Amgen, acted as an expert witness for Amgen (uncompensated), and received research funding from Amgen, Merck Serono, and Roche. MZK is in receipt of a British Heart Foundation Clinical Research Training Fellowship FS/12/15/29380. All other authors have no competing interests.

  • Provenance and peer review Commissioned; externally peer reviewed.

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