Anthracycline-Induced Cardiac Toxicity: Mechanism, Risk Factors, And Treatment

Anthracycline Chemotherapy and Cardiac Toxicity

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).

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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).

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 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 of Anthracycline-Induced Cardiac Toxicity

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).

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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

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)

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).

Risk Factors for Anthracycline-Induced Cardiac Toxicity

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-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.

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.

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.