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Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission
A steadying increase of cancer survivors has been observed as a consequence of more effective therapies. However, chemotherapy regimens are often associated with significant toxicity, and cardiac damage emerges as a prominent clinical issue. Many mechanisms sustain chemotherapy-induced cardiac toxic...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446380/ https://www.ncbi.nlm.nih.gov/pubmed/34540917 http://dx.doi.org/10.3389/fcvm.2021.713694 |
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author | Montisci, Andrea Palmieri, Vittorio Liu, Jennifer E. Vietri, Maria T. Cirri, Silvia Donatelli, Francesco Napoli, Claudio |
author_facet | Montisci, Andrea Palmieri, Vittorio Liu, Jennifer E. Vietri, Maria T. Cirri, Silvia Donatelli, Francesco Napoli, Claudio |
author_sort | Montisci, Andrea |
collection | PubMed |
description | A steadying increase of cancer survivors has been observed as a consequence of more effective therapies. However, chemotherapy regimens are often associated with significant toxicity, and cardiac damage emerges as a prominent clinical issue. Many mechanisms sustain chemotherapy-induced cardiac toxicity: direct myocyte damage, arrhythmia induction, coronary vasospasm, and accelerated atherosclerosis. Anthracyclines are the most studied cardiotoxic drugs and represent a clinical model for cardiac damage induced by chemotherapy. In patients suffering from advanced heart failure (HF) because of chemotherapy-related cardiomyopathy, when refractory to optimal medical therapy, mechanical circulatory support or heart transplantation represents an effective treatment. Here, the main mechanisms of cardiac toxicity induced by cancer therapies are analyzed, with a focus on patients requiring intensive care unit (ICU) admission during the course of the disease because of acute cardiac toxicity, takotsubo syndrome, and acute-on-chronic HF in patients suffering from chemotherapy-induced cardiomyopathy. In a subset of patients, cardiac toxicity can be acute and life-threatening, leading to overt cardiogenic shock. The management of critically ill cancer patients poses a unique challenge and requires a multidisciplinary approach. Moreover, no etiologic therapy is available, and only supportive measures can be implemented. |
format | Online Article Text |
id | pubmed-8446380 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-84463802021-09-18 Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission Montisci, Andrea Palmieri, Vittorio Liu, Jennifer E. Vietri, Maria T. Cirri, Silvia Donatelli, Francesco Napoli, Claudio Front Cardiovasc Med Cardiovascular Medicine A steadying increase of cancer survivors has been observed as a consequence of more effective therapies. However, chemotherapy regimens are often associated with significant toxicity, and cardiac damage emerges as a prominent clinical issue. Many mechanisms sustain chemotherapy-induced cardiac toxicity: direct myocyte damage, arrhythmia induction, coronary vasospasm, and accelerated atherosclerosis. Anthracyclines are the most studied cardiotoxic drugs and represent a clinical model for cardiac damage induced by chemotherapy. In patients suffering from advanced heart failure (HF) because of chemotherapy-related cardiomyopathy, when refractory to optimal medical therapy, mechanical circulatory support or heart transplantation represents an effective treatment. Here, the main mechanisms of cardiac toxicity induced by cancer therapies are analyzed, with a focus on patients requiring intensive care unit (ICU) admission during the course of the disease because of acute cardiac toxicity, takotsubo syndrome, and acute-on-chronic HF in patients suffering from chemotherapy-induced cardiomyopathy. In a subset of patients, cardiac toxicity can be acute and life-threatening, leading to overt cardiogenic shock. The management of critically ill cancer patients poses a unique challenge and requires a multidisciplinary approach. Moreover, no etiologic therapy is available, and only supportive measures can be implemented. Frontiers Media S.A. 2021-09-03 /pmc/articles/PMC8446380/ /pubmed/34540917 http://dx.doi.org/10.3389/fcvm.2021.713694 Text en Copyright © 2021 Montisci, Palmieri, Liu, Vietri, Cirri, Donatelli and Napoli. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Montisci, Andrea Palmieri, Vittorio Liu, Jennifer E. Vietri, Maria T. Cirri, Silvia Donatelli, Francesco Napoli, Claudio Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission |
title | Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission |
title_full | Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission |
title_fullStr | Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission |
title_full_unstemmed | Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission |
title_short | Severe Cardiac Toxicity Induced by Cancer Therapies Requiring Intensive Care Unit Admission |
title_sort | severe cardiac toxicity induced by cancer therapies requiring intensive care unit admission |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446380/ https://www.ncbi.nlm.nih.gov/pubmed/34540917 http://dx.doi.org/10.3389/fcvm.2021.713694 |
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