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cardiotoxicity can be characterised into three types depending on the time
since treatment. These are: acute, early-onset and late cardiotoxicity.1
Acute cardiotoxicity happens either during anthracycline infusion or within two
weeks of treatment. The majority of patients suffering from acute
cardiotoxicity present with sinus tachycardia (increased heartbeat due to excessive
rapid firing of sinoatrial node). There have also been reports of arrhythmias
including ventricular tachycardia (type of regular & fast heart rate due to
inappropriate electrical activity in ventricles). The occurrence of acute
cardiotoxicity is estimated to be less than 1%.


Early-onset cardiotoxicity
is the most frequent and tends to occur within one year after the anthracycline
Affected patients may develop electrophysiological changes, left-ventricular
dysfunction and symptoms of clinical heart failure (e.g. dyspnoea, oedema in
legs, ankles, rapid or irregular heartbeat). Symptoms of heart failure most commonly
appear three months after the last anthracycline dose and mortality in individuals
affected is quite high if treatment is not received in time. In a study
involving more than 4000 patients receiving doxorubicin, 2.2.% of the
individuals presented with clinical signs & symptoms of congestive heart
The study was based on clinician-identified signs of heart failure so any decreases
in left ventricular function without obvious were not identified.

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Late cardiotoxicity
is a major concern where anthracycline is used for curative or adjuvant
treatments. For example, anthracyclines are one of the most commonly used therapies
when treating breast cancer.4
Individuals affected may initially be asymptomatic but arrhythmias can present
even decades after the termination of anthracycline therapy.


Patients affected
by late anthracycline-induced cardiotoxicity tend to have lower ejection
fractions as well as left ventricular dysfunction. Ejection fraction is the
amount of blood ejected from the left ventricle every time the heart beats,
with the normal range being around 50-70%.5
For example, a 43-year old man showed clinical signs of heart failure when
admitted for second recurrence of anaplastic lymphoma, having been originally diagnosed
with lymphoma 28 years prior.6
His left ventricular cardiac ejection fraction was 36%.



Early Detection of Anthracycline Cardiotoxicity and Improvement with Heart
Failure Therapy







Delayed anthracycline-induced cardiomyopathy – case report
Elzbieta Wiater, Grzegorz Charlinksi, Malgorzata Magon-Golinska

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