Immune Checkpoint Inhibitor (ICI)-Associated Myocarditis

ICIs, used to treat various cancers, can trigger immune-mediated myocarditis, a rare but life-threatening inflammation of the heart muscle. Symptoms range from fatigue to arrhythmias or acute heart failure. Immediate discontinuation of ICIs is critical. High-dose corticosteroids (e.g., prednisone) are first-line therapy. Severe cases may require immunosuppressants (e.g., infliximab) or IV immunoglobulin. Cardiac monitoring and collaboration with oncologists and cardiologist specialized in cardio-oncology are essential to balance cancer treatment and cardiac recovery.

Cancer Therapy-Related Heart Failure

Chemotherapy agents (e.g., anthracyclines, HER2-targeted therapies) can cause cardiomyocyte damage, leading to left ventricular dysfunction and heart failure. Early signs include shortness of breath and reduced exercise tolerance. Initiate cardioprotective medications (e.g., RAS inhibitors, beta-blockers) at the first sign of dysfunction. Dose modification or alternative cancer therapies maybe considered.

Cancer Therapy-Induced Hypertension

Vascular endothelial growth factor (VEGF) inhibitors (e.g., bevacizumab etc) commonly cause hypertension due to vascular dysfunction. Uncontrolled hypertension increases risks of cardiovascular events. Blood pressure management with ACE inhibitors, calcium channel blockers, or beta-blockers maybe considered in different conditions. Regular BP monitoring and dose adjustments of VEGF inhibitors are crucial. Lifestyle modifications (e.g., sodium restriction) complement pharmacological interventions.

Cancer Therapy-Associated Vascular Disease

Certain therapies (e.g., VEGF inhibitors, radiation) damage vascular endothelium, increasing risks of thrombosis, atherosclerosis, or arterial dissection. Antithrombotic agents (e.g., aspirin, anticoagulants) for thrombosis prevention. Statins may reduce atherosclerosis progression. For radiation-induced vascular injury, surgical intervention (e.g., stenting) may also be considered for stenotic lesions.

Cancer Therapy-Related Arrhythmias

Arrhythmias, such as atrial fibrillation or QT prolongation, may arise from chemotherapies (e.g., arsenic trioxide) or tyrosine kinase inhibitors (e.g., ibrutinib). Antiarrhythmic drugs maybe considered for symptomatic cases. QT-prolonging agents require electrolyte monitoring and dose adjustments. Catheter ablation may be considered for refractory arrhythmias. Collaboration with oncologists and cardiologist specialized in cardio-oncology to modify causative therapies is key.

Radiation-Induced Cardiovascular Injury

Thoracic radiation can cause pericarditis, coronary artery disease, valvular dysfunction, or restrictive cardiomyopathy, often emerging years post-treatment. Regular cardiac imaging (e.g., echocardiography, CT angiography) for early detection. Statins and antianginal medications manage coronary disease. Severe valvular or pericardial complications may require surgery (e.g., valve replacement, pericardiectomy).