Cardio-oncology refers to the management of cardiac conditions in patients receiving chemotherapy, radiation therapy, and immuno therapy.
As treatment options become available, survival from cancer improves, and the general population ages, makes this an increasingly important field.
Most information is focused on the effects of cancer therapy on the working myocardium, that leads to changes in ejection fraction, and on the cell layers comprising the coronary arteries, that would result in premature ischemic heart disease.
Patients receiving potentially cardiotoxic cancer therapy should be assessed for pre-existing cardiovascular disease, underlying cardiovascular risk factors, and previous exposure to cancer therapy.
Baseline cardiac imaging, including echocardiographic studies and 12 lead EKG should be performed before cancer therapy is started according to the patient’s risk of cardiotoxicity and arrhythmias, respectively.
Radiation to the mediastinum carries a dose dependent risk of early degenerative valve disease, coronary artery disease, pericardial disease, and restrictive cardiomyopathy.
Electrical conduction disorders of the heart are estimated to occur in 4-5% of those who receive radiation therapy.
Radiation affects a thought to be secondary to inflammatory process induced by radiation and the effects of radiation induced ischemia with subsequent fibrosis.
A cardio-oncologist is a specialist who helps people with cancer prevent or manage heart disease.
Cardio-oncologists diagnose and treat a range of heart issues caused by cancer treatment cardiotoxicities.
They also manage heart disease from other causes like aging.
They provide care before, during and after cancer treatment.
Clinicians should screen for and actively manage modifiable cardiovascular risk factors, such as smoking, hypertension, diabetes, dyslipidemia, and obesity, and control of cardiac risk factors, including hypertension, hyperlipidemia, diabetes with modifications in diet, and exercise may decrease the likelihood of adverse cardiotoxic effects from cancer therapy.
Cardio-oncologists are cardiologists or oncologists who provide care to people diagnosed with cancer.
Cardio-oncology focuses on identifying, monitoring and treating cardiovascular diseases caused by cancer therapies.
The goal is to reduce the side effects of cancer treatment on the cardiovascular system.
Cardio-oncologists are medical doctors who are specialists in their fields (cardiology or oncology).
As the number of cancer survivors increases, so does the number of people who experience side effects from treatment.
About 7 in 10 people who survive cancer are at least 65 years old.
As cancer survivors get older, they may face heart risks from their cancer treatment, plus increased risks from aging, lifestyle factors and associated medical conditions.
Cardio-oncologists help manage many different heart problems, including:
Arrhythmias, like atrial fibrillation and Torsade de Pointes. Coronary artery disease. Heart failure. Heart valve disease. High blood pressure (hypertension). Restrictive cardiomyopathy.
Anthracyclines are the most well-known cardiotoxic agents, including doxorubicin (Adriamycin), daunorubicin, epirubicin, and idarubicin.
The commonly used anthracycline chemotherapy agents can induce cardiomyopathy and congestive heart failure.
Targeted therapies like trastuzumab (Herceptin) also pose cardiac risks, particularly when used to treat HER2-positive breast cancers.
The mechanism differs from anthracyclines, often involving interference with protective cardiac signaling pathways.
Multiple types of cancer treatment related cardiac dysfunction include heart failure, vascular toxicities, arrhythmias/corrected QT prolongation, hypertension, and myocarditis.
Hypertension may result from targeted therapies, including tyrosine kinase inhibitors, proteasome inhibitors, and target of rapamycin inhibitors.
Cardiac electrophysiology may be altered by cancer treatments and include an arrhythmia is.
Taxanes may cause bradycardia, AV block, or ventricular tachycardia.
Therapy induced prolongation of the QTc interval with CDK4/6 inhibitors may predispose to life-threatening arrhythmias.
Statins, MRAs, ACEIs, and beta-blockers can significantly attenuate chemotherapy-induced cardiotoxicity, while ARBs showed no significant effects.
Dexrazoxane is the only FDA-approved drug for treating anthracycline induced cardiotoxicity, but it also has drawbacks and adverse effects.
Dexrazoxane mitigates the risk of heart failure, in patients receiving anthracuclines but has not been widely adopted due to concerns of decreased efficacy and myelosuppression in those with metastatic breast cancer.
Bruton tyrosine inhibitors are associated with atrial fibrillation with an estimated incidence of 3 to 16%.
Patients starting such drugs should undergo baseline, cardiac evaluation, and routine monitoring with EKG to help detect AF.
If AF is diagnosed beta blockers are generally preferred for rate control.
Vascular endothelial growth factors (VEGF) frequently induce hypertension (30–80%).
Proteasome inhibitors can lead to hypertension and heart failure.
Anaplastic lymphoma kinase inhibitors can cause bradyarrhythmias and conduction block.
Tyrosine kinase inhibitors such as sunitinib is life sustaining in advanced renal cancer, but is associated with increased risk of hypertension.
Postmenopausal women with early stage breast cancer, or a greater risk of mortality from cardiovascular disease, then from a recurrence of their cancer.
Inhibitors of the BCR-Abl fusion protein pose an arterial occlusion risk of up to 20% mandating vigilance for myocardial infarction, stroke, or peripheral arterial disease.
Atrial fibrillation, atrial flutter, and heart failure are common complications with a five-year incidence of about 14% in patients undergoing hematopoietic cell transplantation.
CAR-T cell therapy can provoke cytokinin release syndrome and associated cardiovascular instability: such manifestations include hypotension, arrhythmias, and reduced left ventricular function.
PIK3CA inhibitors are associated with hyperglycemia, which can contribute to the metabolic syndrome.
Immune checkpoint inhibitors are associated with cardiovascular toxicity, including myocarditis.