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Cardiovascular Oncologic Emergencies

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Oncologic Emergency Medicine

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Abstract

The number of patients with cancer-related cardiovascular disorders is increasing. This is attributed to increased survival of cancer patients who live longer (and are thus at risk for age-related cardiovascular disease) and the cardiovascular toxicities of many newer cancer drugs. Anthracyclines have been long associated with the development of dilated cardiomyopathy, especially when used with trastuzumab. Antiangiogenic targeted therapies cause new or worsening of pre-existing hypertension. Immune checkpoint inhibitors (ICIs) are associated with an increased incidence of myocarditis, while radiation therapy is associated with ischemic heart disease, valve dysfunction, conduction abnormalities, pericardial disease, and cardiomyopathy. Additionally, some cytotoxic chemotherapeutics, such as cisplatin, increase the risk of venous thromboembolism, while some antimetabolites such as fluoropyrimidines have long been associated with a broad range of cardiotoxicities. This chapter focuses on the cardiovascular conditions associated with cancer and its management, including cardiomyopathy, myocarditis, arrhythmia, valvular heart disease, and ischemic and non-ischemic vascular disease. As with any pathologic entity, the frontline efforts are geared toward treatment of those with the most emergent or severe manifestations of the disease. Simultaneous efforts are targeted at prevention of the occurrence or progression of disease. Here, we briefly discuss putative underlying mechanisms whereby cancer and its treatments can lead to the development of emergent cardiovascular conditions in oncologic patients and provide guidance for clinicians. Finally, we end the chapter with brief comments on implications for cardio-oncology during the COVID-19 pandemic and beyond.

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Authors and Affiliations

  1. Roger Williams Medical Center, Department of Medicine, Boston University School of Medicine, Providence, RI, USA

    Tarek Nafee & Dany Debs

  2. Department of Medicine, Rush University Medical Center, Chicago, IL, USA

    Maria Isabel Camara Planek, Allison Zimmerman & Tochukwu M. Okwuosa

  3. Department of Medicine, Cardiology, College of Medicine, University of Florida, Gainesville, FL, USA

    Tawanna Charlton

  4. Division of General Internal Medicine, Department of Medicine, Cardiology, University of Florida, Gainesville, FL, USA

    Michelle Dimza

  5. Department of Cardiology, Austin Health & The University of Melbourne, Melbourne, VIC, Australia

    Alexandra Murphy

  6. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK

    Stephen Dobbin & Ninian N. Lang

  7. Barts Heart Centre, Barts NHS Health Trust, Department of Cardiology, St. Bartholomew’s Hospital, London, England, UK

    Sara Tyebally & Arjun K. Ghosh

  8. Division of Cardiology, Department of Internal Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA

    Tarek Barbar & Syed S. Mahmood

  9. Department of Medicine, Cardiology Division, Perkin Center for Heart Failure, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA

    Evelyn Horn

  10. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Umberto Campia

  11. UF Women’s Cardiovascular Health Sciences, Malcom Randall VAMC, Division of Cardiovascular Medicine, Department of Medicine, Cardiology, University of Florida, Gainesville, FL, USA

    Ki Park

  12. Division of Cardiovascular Medicine, Department of Medicine, Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Michael G. Fradley

  13. Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK

    Rhian M. Touyz

  14. Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Sherry-Ann Brown

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  1. Tarek Nafee
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Correspondence to Sherry-Ann Brown .

Editor information

Editors and Affiliations

  1. Former Professor and Founding Chair (Retired), The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Knox H. Todd

  2. Professor and Chair, Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA

    Charles R. Thomas, Jr.

  3. Professor and Chair, Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kumar Alagappan

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Nafee, T. et al. (2021). Cardiovascular Oncologic Emergencies. In: Todd, K.H., Thomas, Jr., C.R., Alagappan, K. (eds) Oncologic Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-67123-5_21

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