Cardiac Emergencies in Cancer Patients

  • Patrick ChaftariEmail author
  • Elie Mouhayar
  • Cezar Iliescu
  • Saamir A. Hassan
  • Peter Kim
Part of the MD Anderson Cancer Care Series book series (MDCCS)


Cardiac problems can occur at any time in cancer patients and be true medical challenges for physicians in an emergency center. The most important symptoms of heart disease include dyspnea, chest pain, chest discomfort, syncope, collapse, palpitation, edema, cough, hemoptysis, and excess fatigue. These symptoms are more common in patients with cancer than in those without it and are frequently nonspecific. Evaluation and management of cardiac emergencies in cancer patients may be challenging and may have to be individualized.

This chapter covers some of the most frequent cardiac emergencies in cancer patients we encounter at our emergency center: cardiac arrhythmias, acute coronary syndrome (ACS, heart failure emergencies, hypertensive emergencies, and pericardial disease-related emergencies. Clinicians must take into account the patient’s previous and ongoing cancer treatment to optimize treatment strategies for these emergencies.


Cancer Cardiac emergencies Oncologic emergencies Arrhythmia Acute coronary syndrome Heart failure Hypertensive emergencies Pericardial disease Tamponade 

Suggested Readings

  1. 2012 Writing Committee Members, Jneid H, Anderson JL, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2012;126:875–910.Google Scholar
  2. Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation. 2003;108:1871–909.CrossRefPubMedGoogle Scholar
  3. Cardinale D, Colombo A, Sandri MT, et al. Prevention of high-dose chemotherapy-induced cardiotoxicity in high-risk patients by angiotensin-converting enzyme inhibition. Circulation. 2006;114:2474–81.CrossRefPubMedGoogle Scholar
  4. De Giorgi V, Grazzini M, Gandini S, et al. Treatment with beta-blockers and reduced disease progression in patients with thick melanoma. Arch Intern Med. 2011;171:779–81.PubMedGoogle Scholar
  5. European Heart Rhythm Association; Heart Rhythm Society, Zipes DP, Camm AJ, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol. 2006;48:e247–e346.Google Scholar
  6. Floyd JD, Nguyen DT, Lobins RL, Bashir Q, Doll DC, Perry MC. Cardiotoxicity of cancer therapy. J Clin Oncol. 2005;23:7685–96.CrossRefPubMedGoogle Scholar
  7. Frickhofen N, Beck FJ, Jung B, Fuhr HG, Andrasch H, Sigmund M. Capecitabine can induce acute coronary syndrome similar to 5-fluorouracil. Ann Oncol. 2002;13:797–801.CrossRefPubMedGoogle Scholar
  8. Gilard M, Arnaud B, Cornily JC, et al. Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: the randomized, double-blind OCLA (omeprazole clopidogrel aspirin) study. J Am Coll Cardiol. 2008;51:256–60.CrossRefPubMedGoogle Scholar
  9. Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119:e391–479.CrossRefPubMedGoogle Scholar
  10. Imazio M. Pericarditis: pathophysiology, diagnosis, and management. Curr Infect Dis Rep. 2011;13:308–16.CrossRefPubMedGoogle Scholar
  11. Imazio M, Brucato A, Mayosi BM, et al. Medical therapy of pericardial diseases: part II: noninfectious pericarditis, pericardial effusion and constrictive pericarditis. J Cardiovasc Med (Hagerstown). 2010a;11:785–94.CrossRefGoogle Scholar
  12. Imazio M, Trinchero R, Brucato A, et al. Colchicine for the prevention of the post-pericardiotomy syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial. Eur Heart J. 2010b;31:2749–54.CrossRefPubMedGoogle Scholar
  13. James PA, Oparil S, Carter BL, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eight Joint National Committee (JNC 8). JAMA. 2014;311:507–20.CrossRefPubMedGoogle Scholar
  14. Kalay N, Basar E, Ozdogru I, et al. Protective effects of carvedilol against anthracycline-induced cardiomyopathy. J Am Coll Cardiol. 2006;48:2258–62.CrossRefPubMedGoogle Scholar
  15. Kamba T, McDonald DM. Mechanisms of adverse effects of anti-VEGF therapy for cancer. Br J Cancer. 2007;96:1788–95.PubMedCentralCrossRefPubMedGoogle Scholar
  16. Ketch T, Biaggioni I, Robertson R, Robertson D. Four faces of baroreflex failure: hypertensive crisis, volatile hypertension, orthostatic tachycardia, and malignant vagotonia. Circulation. 2002;105:2518–23.CrossRefPubMedGoogle Scholar
  17. Kilickap S, Abali H, Celik I. Bevacizumab, bleeding, thrombosis, and warfarin. J Clin Oncol. 2003;21:3542. author reply 3543.CrossRefPubMedGoogle Scholar
  18. Lotrionte M, Biondi-Zoccai G, Imazio M, et al. International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences. Am Heart J. 2010;160:662–70.CrossRefPubMedGoogle Scholar
  19. Maitland ML, Bakris GL, Black HR, et al. Initial assessment, surveillance, and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors. J Natl Cancer Inst. 2010;102:596–604.PubMedCentralCrossRefPubMedGoogle Scholar
  20. Mouhayar E, Salahudeen A. Hypertension in cancer patients. Tex Heart Inst J. 2011;38:263–5.PubMedCentralPubMedGoogle Scholar
  21. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:529–55.CrossRefPubMedGoogle Scholar
  22. Ohnishi K, Yoshida H, Shigeno K, et al. Prolongation of the QT interval and ventricular tachycardia in patients treated with arsenic trioxide for acute promyelocytic leukemia. Ann Intern Med. 2000;133:881–5.CrossRefPubMedGoogle Scholar
  23. Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel Jr EL. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291:2441–7.CrossRefPubMedGoogle Scholar
  24. Tsavaris N, Kosmas C, Vadiaka M, et al. Cardiotoxicity following different doses and schedules of 5-fluorouracil administration for malignancy – a survey of 427 patients. Med Sci Monit. 2002;8:PI51–7.PubMedGoogle Scholar
  25. Wouters KA, Kremer LC, Miller TL, Herman EH, Lipshultz SE. Protecting against anthracycline-induced myocardial damage: a review of the most promising strategies. Br J Haematol. 2005;131:561–78.CrossRefPubMedGoogle Scholar
  26. Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am Coll Cardiol. 2009;53:2231–47.CrossRefPubMedGoogle Scholar
  27. Yusuf SW, Iliescu C, Bathina JD, Daher IN, Durand JB. Antiplatelet therapy and percutaneous coronary intervention in patients with acute coronary syndrome and thrombocytopenia. Tex Heart Inst J. 2010;37:336–40.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Patrick Chaftari
    • 1
    Email author
  • Elie Mouhayar
    • 2
  • Cezar Iliescu
    • 2
  • Saamir A. Hassan
    • 2
  • Peter Kim
    • 2
  1. 1.Department of Emergency Medicine, Unit 1468The University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of CardiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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