Synopsis
Prevent, detect and manage cardiovascular toxicity from cancer therapy while preserving effective anticancer treatment through risk-adapted surveillance and multidisciplinary decisions.
- Perform baseline cardiovascular risk assessment before a potentially cardiotoxic cancer therapy; the intensity of surveillance should match treatment and patient risk.
- Record previous cardiovascular disease and cancer treatment, examination, blood pressure, ECG and relevant blood tests; use echocardiography with LVEF and GLS when the regimen or risk warrants it.
- Anthracycline toxicity is related to cumulative exposure; HER2-targeted treatment commonly causes left-ventricular dysfunction that may improve with interruption and cardiac therapy.
Key red flags
Chest pain, dyspnoea, palpitations, syncope, troponin rise, new ECG change, AV block or ventricular arrhythmia; associated skeletal-muscle weakness, ptosis or dysphagia heightens concern.
Investigation priorities
Define pre-existing disease and therapy-specific risk before treatment.
Management branches
A cancer therapy with recognised cardiovascular toxicity is planned.
- Identify previous cardiovascular disease, risk factors, pregnancy potential, earlier anthracycline/HER2 therapy and thoracic radiotherapy; examine and record BP.
- Obtain ECG and relevant blood tests; arrange LVEF/GLS and baseline biomarkers according to the planned treatment and risk.
Key medicines
Methylprednisolone followed by prednisolone for ICI myocarditisMethylprednisolone 500–1000 mg IV once daily for 3–5 days once ICI myocarditis is considered likely. If troponin falls by more than 50% from peak within 24–72 hours and LV dysfunction, AV block and arrhythmias resolve, switch to prednisolone 1 mg/kg orally once daily, maximum 80 mg/day, then taper under specialist surveillance.