Cardiac Toxicity from Anthracyclines: A Comprehensive Overview

This report provides an overview of cardiac toxicity, a heart condition caused by anthracycline chemotherapy drugs commonly used in cancer treatment. It delves into the pathophysiology of the disease, explaining how anthracyclines damage the heart through processes like proteolysis, necrosis, apoptosis, and fibrosis. The report also identifies risk factors associated with cardiac toxicity, such as age, sex, cumulative drug dose, and pre-existing cardiac conditions. Furthermore, it discusses treatment options, including ACE inhibitors, beta-blockers, and diuretics, aimed at managing heart failure and its symptoms. The report concludes by emphasizing the importance of early detection and preventive strategies to mitigate the long-term effects of anthracycline-induced cardiac toxicity, highlighting the role of healthcare professionals in ensuring patient health and recovery.

Running Head: HEALTH 0
Health
9/27/2018

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Contents
Introduction................................................................................................................................2
Pathophysiology of Cardiac toxicity..........................................................................................2
Treatment for cardiac toxicity....................................................................................................4
Conclusion..................................................................................................................................4
References..................................................................................................................................6

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Introduction
The report brings about the discussion of one of the most common health issue, which affects
the wellbeing of an individual. The discussion relates to the cardiac toxicity, or the heart
diseases caused by the anthracycline chemotherapy medicines. The disease is considered as
the serious side effects of these anthracycline agents. Individual as well as healthcare settings
must take care of their patients, dealing with such health issues. Anthracycline such as
doxorubicin and idarubicin are included as an important class of chemotherapeutic agents;
identified as drugs in cancer chemotherapy (Cardinale et al., 2015).
Anthracycline drugs extracted from Streptomyces peucetius, used to treat many cancers
include leukaemia, breast, stomach, uterine, bladder, and lung cancers. These drugs can cause
cardiac toxicity and the severity of the disease may range from minor effects, which can be
treated with medications, or person may require urgent admission in the hospital. A person
with the disease of cardiac toxicity suffers from a number of symptoms, such as fatigue,
shortness of breath, and others. Therefore, report in the later part discusses about the
treatment, pathophysiology of the disease caused by anthracycline (Ewer and Ewer, 2015).
Pathophysiology of Cardiac toxicity
The term pathophysiology refers to the convergence of pathology into physiology, in clinical
terms. Pathology relates to the description of the conditions, observed during the state of the
disease. Physiology means identification of the processes or mechanism operating within the
human body. Pathophysiology defines about the functional changes related or resulted from
the disease or injury, i.e. it describes about the disordered physiological functions or
processes of the individual (Bloom et al., 2016).
Anthracyclines are used as chemotherapeutic agents, used in the treatment of cancers, and
these types of medications stop the growth of rapidly dividing cells in the body, which may
be both cancerous and non-cancerous. Cardio toxicity is defined as “toxicity that affects the
heart,” and it mentions about cardiac dysfunction, heart failure, and several other issues. In
simple terms, it explains about the damage to the heart by harmful chemicals. A person may
be given certain drugs or medicines to prevent occurrence of cancer, as drugs kills the cells
causing cancer. Cardiac toxicity is most observed in people who are older in age, young
children and women are at greater risk. The common symptoms observed in the patients with

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cardiac toxicity include chest pain, or changes in the heart rhythm (Galluzzi et al., 2015).
There may be a decline in the LVEF (Left ventricular ejection fraction), in some cases, which
states that the heart does not pump blood in each heartbeat of the person. In severe condition
the person, may face problem of congestive heart failure, and the person get tired easily and
fall short of breath. Especially observed in the cancer patients, the cause of cardiac toxicity is
the chemotherapy drugs given to the patient (Raj, Franco, and Lipshultz, 2014).
 Shortness of breath, tiredness
 Decline in the LVEF, i.e. LV ejection fraction less than 55%.
 Gain in the weight due to heart failure
 Swelling in the ankles
Pathophysiology in context to the disease or issue of cardiac toxicity described as an
important practice in the management of the healthcare. Research to find effective treatment
for anthracycline-induced cardio-toxicity, it has been understood that there is no preventive
drug developed in the clinical practices. It is because anthracycline-induced cardio-toxicity
can lead to the condition causing irreversible damage to myocardium. The pathophysiology
of the cardiac toxicity to anthracycline is characterised by the myocardial damage caused due
to proteolysis, necrosis, apoptosis, and fibrosis (Whiteside et al., 2018).
Studies in relation to the anthracycline as common chemotherapeutic agents used in treating
cancers involve mechanisms that are often perceived as multifactorial in nature.
Anthracycline induces several forms of cellular injury, by free radical production. To
decrease or prevent side effects or problems from anthracycline cardiac toxicity, number of
strategies tested, but no specific therapies used to prevent anthracycline induced cardiac
dysfunction. A number of risk factors are associated with the dysfunction of cardiac system,
or heart problems caused due to anthracycline chemotherapeutic agents. Pathophysiology of
cardiac toxicity also describes about the incidence of the disease that depends upon different
factors related to oncological therapies, i.e. type of drug, dose administered during each
cycle, schedule of administration, and their association with the patients risk factors or
previous cardiovascular disease or any therapy given to the patient. The risk factors in
context to cardiac issues and their effects are listed in the table given below.
Risk factors Effects

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Abnormal cardiac
function
Higher risk for higher chronic cardiac dysfunction
Cumulative dose Effecting or increasing risk for chronic cardiac dysfunction
Age Younger age leads to greater cardiac toxicity (Milks et al.,
2018).
Sex Females are more vulnerable
Irradiation Concomitant mantle irradiation is a major disposing factor
Length of follow-up Longer length of follow-up process leads to higher cardiac
toxicity in patients (Madan et al., 2015)
Treatment for cardiac toxicity
A patient dealing with the side effects of anthracycline chemotherapeutic agents must be
diagnosed and given proper treatment. It is also essential to investigate the presence of the
associated risk factors before starting the treatment or therapy for the disease. Treatment as
therapies must be used in congestive heart failure or cardiac toxicity caused due to
anthracycline agents (Garg and Vorobiof, 2016). Therapies include ACE inhibitors, beta-
blockers, and loop diuretics for volume management. Diuretics helps in preventing or treating
heart failure by increasing urination rates, through making body get rid of the excess fluids. It
also leads to easy pumping of blood by the heart. Other methods include digitalis drugs,
making heartbeat rates more effective, which ultimately address the problem of atrial
fibrillation, atrial fluttering, and other heart damages. Preventive measures for cardiac
toxicity include application of the cardio protective agents. Proper physical examination of
heart problems, and intake of effective drugs, or medications, prevent from such cardiac or
heart-related diseases (Vejpongsa and Yeh, 2014).
Conclusion
To conclude the above discussion it has been analysed that health of an individual by a wide
variety of factors and diseases. One of them, include cardiovascular diseases, which refers to
cardiac toxicity or cardiac failure of an individual. Early detection of Anthracycline toxicity
will help the healthcare professionals in healthcare settings, to implement preventive
strategies for the same. The negative effects of the anthracycline antibiotics may create long-

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term illness or congestive heart failure. Identifying symptoms, diagnosis, treatment, and
feedback is essential for such patients, to lead them towards their improvement and help them
recover. In the above assignment, as I have stated about cardiac toxicity and the treatment for
the same, for the reader and the healthcare professionals must develop their systems effective
to improve the health condition of such patients. Diuretics are found to be effective with such
cases, and their treatment, and one must take care and prevent the occurrence of such health
issue. Hence, individuals and healthcare professional must identify such issues and take
preventive measures towards ensuring patient’s health and recovery.

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References
Bloom, M.W., Hamo, C.E., Cardinale, D., Ky, B., Nohria, A., Baer, L., Skopicki, H.,
Lenihan, D.J., Gheorghiade, M., Lyon, A.R. and Butler, J. (2016) Cancer Therapy–Related
Cardiac Dysfunction and Heart Failure: Part 1: Definitions, Pathophysiology, Risk Factors,
and Imaging. Circulation: Heart Failure, 9(1), p. 2661.
Cardinale, D., Colombo, A., Bacchiani, G., Tedeschi, I., Meroni, C.A., Veglia, F., Civelli,
M., Lamantia, G., Colombo, N., Curigliano, G. and Fiorentini, C. (2015) Early detection of
anthracycline cardio toxicity and improvement with heart failure therapy. Circulation,
131(22), p. 114.
Ewer, M.S. and Ewer, S.M. (2015) Cardio toxicity of anti-cancer treatments. Nature Reviews
Cardiology, 12(9), p. 547.
Galluzzi, L., Buque, A., Kepp, O., Zitvogel, L., and Kroemer, G. (2015) Immunological
effects of conventional chemotherapy and targeted anticancer agents. Cancer cell, 28(6),
pp.690-714.
Garg, V. and Vorobiof, G. (2016) Echocardiography and alternative cardiac imaging
strategies for long-term cardio toxicity surveillance of cancer survivors treated with
chemotherapy and/or radiation exposure. Current oncology reports, 18(8), p.52.
Madan, R., Benson, R., Sharma, D.N., Julka, P.K., and Rath, G.K. (2015) Radiation induced
heart disease: pathogenesis, management, and review literature. Journal of the Egyptian
National Cancer Institute, 27(4), pp. 187-193.
Milks, M.W., Velez, M.R., Mehta, N., Ishola, A., Van Houten, T., Yildiz, V.O., Reinbolt, R.,
Lustberg, M., Smith, S.A. and Orsinelli, D.A. (2018) Usefulness of Integrating Heart Failure
Risk Factors Into Impairment of Global Longitudinal Strain to Predict Anthracycline-Related
Cardiac Dysfunction. The American journal of cardiology, 121(7), pp.867-873.
Raj, S., Franco, V.I. and Lipshultz, S.E. (2014) Anthracycline-induced cardio toxicity: a
review of pathophysiology, diagnosis, and treatment. Current treatment options in
cardiovascular medicine, 16(6), p.315.

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Vejpongsa, P. and Yeh, E.T. (2014) Prevention of anthracycline-induced cardio toxicity:
challenges and opportunities. Journal of the American College of Cardiology, 64(9), pp. 938-
945.
Whiteside, H., Nagabandi, A., Jyothidasan, A., Brown, K., and Thornton, J. (2018) Acute
anthracycline induced cardio toxicity: A rare and reversible cause of acute systolic heart
failure. Journal of the American College of Cardiology, 71(11), p. 2356.