Principles of Critical Care > Part VII. Hematologic and Oncologic Disorders > Chapter 74. Toxicities of Chemotherapy Apurva A. Desai Gini Fleming

Cardiovascular Toxicity

"(See ref. 25.) The vast majority of cardiac events in cancer patients are related to pre-existing heart disease or to involvement of the myocardium or pericardium by tumor, not to anticancer drugs, most of which produce cardiac damage rarely and sporadically, if at all (Table 74-4). Anthracyclines are the exception. Doxorubicin and daunorubicin have very similar effects on the heart; doxorubicin is used much more commonly, and its cardiac effects have been better studied. Trastuzumab also has been reported to cause cardiac dysfunction in patients that is similar to the cardiomyopathy associated with anthracyline therapy.²⁶ Cardiovascular toxicity is also associated with the use of immunomodulatory agents such as interferon and interleukin-2 (IL-2), which will be addressed separately in the section describing the toxicities associated with biologic agents. Cisplatin and other drugs may produce secondary effects through alterations in plasma potassium, calcium, and magnesium levels. Direct effects appear to be caused mainly by the anthracyclines and paclitaxel. Electrocardiographic (ECG) changes occur in up to 40% of patients during doxorubicin infusion. The most frequently noted effects are nonspecific ST-T wave changes, but premature atrial and ventricular contractions, sinus tachycardia, and decreased QRS voltage are also common; almost every conceivable type of arrhythmia has been reported. While sudden death attributed to acute anthracycline-induced arrhythmia has been reported, it is extremely rare; cardiac monitoring during drug infusion is not warranted...."