Cancer treatment-related cardiotoxicity

Dilated cardiomyopathy is left ventricular (often biventricular) dilation with systolic dysfunction not explained by loading conditions or coronary disease, from genetic, viral, toxic, or peripartum causes, presenting as heart failure with reduced ejection fraction. Diagnosis is by echocardiography with a workup for reversible causes, and treatment is guideline-directed heart-failure therapy with device therapy for high-risk patients.

Radiation therapy toxicity is organ injury from therapeutic ionizing radiation given for cancer, split into acute toxicities from direct cytotoxic injury during treatment and late toxicities from progressive fibrosis appearing months to decades later in the treated field. Diagnosis correlates symptom timing and imaging pattern with the radiation field after excluding recurrence and infection; management is organ-specific and supportive, plus lifelong surveillance for secondary malignancy.

Soft tissue sarcoma is a diverse group of mesenchymal malignancies of fat, muscle, nerve, vessel, and fibrous tissue, confirmed only by biopsy and staged mainly by histologic grade and hematogenous (usually pulmonary) spread. A mass 5 cm or larger, deep to fascia, fixed, rapidly enlarging, recurrent, or painful without explanation should be imaged and biopsied before any excision.

Immune checkpoint inhibitor toxicity is the set of autoimmune-like immune-related adverse events (irAEs) that follow blockade of CTLA-4, PD-1, or PD-L1, most often colitis, hepatitis, pneumonitis, dermatitis, and endocrinopathy. Diagnosis relies on excluding infection and grading severity; first-line treatment for grade 2 or higher toxicity is oral or intravenous corticosteroids with the checkpoint inhibitor held or permanently stopped.

Acute coronary syndrome is the umbrella term for unstable angina, NSTEMI, and STEMI, all arising from plaque rupture or erosion; the presenting ECG and troponin split the spectrum and set the initial recognition, risk-stratification, and treatment pathway before it branches into disease-specific management.

Cardiac amyloidosis is myocardial infiltration by misfolded amyloid fibrils, chiefly transthyretin (ATTR) or light-chain (AL) type, causing a restrictive, thick-walled cardiomyopathy with heart failure, conduction disease, and low-voltage ECG despite increased wall thickness. Diagnosis distinguishes AL (light chains plus biopsy) from ATTR (a positive bone-tracer scan without a plasma cell disorder), and treatment is type-specific plus supportive heart-failure care.

Constrictive pericarditis is a rigid, often calcified pericardium that impairs diastolic filling, causing predominantly right-sided heart failure. It follows pericardial injury (post-surgical, tuberculous, radiation, or idiopathic), is distinguished from restrictive cardiomyopathy by hemodynamic and imaging features, and definitive treatment is pericardiectomy.

Myocarditis is inflammation of the myocardium, most often postviral or immune-mediated, presenting across a spectrum from a mild chest-pain syndrome mimicking myocardial infarction to fulminant heart failure and arrhythmia. Diagnosis relies on cardiac MRI (or biopsy for severe or refractory cases), and treatment is supportive heart-failure care, with cause-specific immunosuppression for giant cell, checkpoint-inhibitor, and autoimmune myocarditis.

Pulmonary embolism is thrombus, usually from a lower-extremity deep vein thrombosis, obstructing the pulmonary arterial circulation and causing V/Q mismatch, right ventricular strain, and hypoxemia. Diagnosis follows Wells criteria (with PERC in low-risk patients) to sequence D-dimer, CT pulmonary angiography, and V/Q scanning, and management is risk-stratified anticoagulation escalating to thrombolysis or embolectomy for hemodynamic instability.

Heart failure is a clinical syndrome of impaired cardiac filling or ejection causing congestion and reduced perfusion, classified by ejection fraction. Diagnosis integrates symptoms, signs, natriuretic peptides, and echocardiography, and treatment of reduced-ejection-fraction disease is quadruple guideline-directed therapy, with device therapy and cause-specific management.

Breast cancer is a malignancy of ductal or lobular epithelium, most often presenting as a firm, painless mass in the upper outer quadrant. Diagnosis rests on core needle biopsy with estrogen, progesterone, and HER2 receptor testing, and first-line treatment pairs breast-conserving surgery or mastectomy with sentinel node biopsy, radiation, and receptor-guided systemic therapy such as tamoxifen or trastuzumab.

Hodgkin lymphoma is a B-cell malignancy defined by Reed-Sternberg cells that classically presents with painless, contiguously spreading cervical or mediastinal lymphadenopathy in a young adult, and it is confirmed by excisional lymph node biopsy. Ann Arbor/Lugano stage and interim PET response drive risk-adapted ABVD chemotherapy with or without radiation, and most patients are cured.

Renal cell carcinoma is the most common kidney cancer, arising from renal tubular epithelium (most often clear cell), and is now diagnosed incidentally on imaging in most patients rather than through the classic triad of flank pain, hematuria, and mass. Contrast CT or MRI showing an enhancing solid renal mass is usually sufficient to diagnose and stage disease, and treatment is surgical for localized tumors versus tyrosine kinase inhibitors and immune checkpoint inhibitors for metastatic, chemo- and radio-resistant disease.

Torsades de pointes is a polymorphic ventricular tachycardia occurring on a background of QT prolongation, with a characteristic twisting of QRS complexes around the baseline. Management is intravenous magnesium, correction of the underlying QT-prolonging cause, and rate acceleration by pacing or isoproterenol; unstable episodes are defibrillated.