Guideline sources The following summarized guidelines for the evaluation and management of cardiotoxicity of cancer therapy are prepared by our editorial team based on guidelines from the European Society of Cardiology (ESC/ESTRO/EHA/IC-OS 2022), the European Society of Medical Oncology (ESMO 2022; 2020), and the Canadian Cardiovascular Society (CCS 2016). 1 2 3 4 Guidelines 1. Classification and risk stratification Risk assessment: obtain cardiovascular toxicity risk stratification in all patients with cancer before initiating potentially cardiotoxic anticancer therapy. B Consider using the HFA-ICOS risk assessment tool for risk stratification. B Communicate the results of the risk assessment to the patient and other appropriate healthcare professionals. B Show 2 more https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 1/12 6/29/23, 3:44 AM Cardiotoxicity of cancer therapy Pathway 2. Diagnostic investigations Cardiovascular assessment: As per ESC 2022 guidelines, obtain a specialist cardiovascular assessment for optimal diagnostic workup and management in patients with cancer presenting with new cardiovascular toxicity during and after cancer treatment. B As per ESMO 2020 guidelines, screen for known cardiovascular risk factors in patients with cancer. Treat identified cardiovascular risk factors according to current guidelines. A Show 2 more Electrocardiogram: As per ESC 2022 guidelines, obtain an ECG as part of the baseline cardiovascular risk assessment in all patients initiating cancer therapy. Refer patients with an abnormal baseline ECG to a cardiologist. B As per ESMO 2020 guidelines, obtain a baseline ECG including measurement of HR QTc in patients requiring treatment with a potentially cardiotoxic treatment. A As per CCS 2016 guidelines, consider obtaining a baseline ECG before initiating QTc- prolonging agents, and periodically during treatment. C Cardiac imaging: As per ESC 2022 guidelines, obtain echocardiography as the first-line modality for the assessment of cardiac function in patients with cancer. B Obtain 3D echocardiography as the preferred echocardiographic modality to measure LVEF. B Assess global longitudinal strain in all patients undergoing echocardiography. B Show 3 more As per ESMO 2020 guidelines, obtain baseline evaluation of LVEF and diastolic function according to accepted comprehensive imaging practice in patients scheduled to undergo anticancer therapy associated with HF or LV dysfunction. A Show 4 more As per CCS 2016 guidelines, assess LVEF before initiating cancer therapy known to cause impairment in LV function. B Show 2 more Cardiac biomarkers: As per ESC 2022 guidelines, obtain baseline measurement of natriuretic peptides and/or cardiac troponin in all patients with cancer at risk of cancer therapy-related cardiac dysfunction if these biomarkers are going to be measured during treatment to detect cancer therapy-related cardiac dysfunction. B As per ESMO 2020 guidelines: Insufficient evidence to recommend the routine use of cardiac biomarkers (high-sensitive cardiac troponins, BNP, or N-terminal pro-BNP) in patients receiving potentially cardiotoxic chemotherapy. Consider obtaining a baseline measurement of such cardiac biomarkers in https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 2/12 6/29/23, 3:44 AM Cardiotoxicity of cancer therapy Pathway high-risk patients (with preexisting significant CVD) and patients receiving high doses of cardiotoxic chemotherapy, such as anthracycline. I Consider measuring cardiac biomarkers in patients undergoing treatment with any cardiotoxic agent and presenting with unexplained signs and symptoms, such as (but not limited to) sinus tachycardia, rapid weight gain, dyspnea, peripheral edema, or ascites. B As per CCS 2016 guidelines, consider obtaining serial measurements of cardiac biomarkers (BNP, troponin) for early detection of cardiotoxicity in patients with cancer receiving cardiotoxic therapies implicated in the development of LV dysfunction. C 3. Medical management Management of arterial hypertension: As per ESC 2022 guidelines, initiate effective treatment for cancer therapy-induced arterial hypertension to prevent cancer treatment interruption and cardiovascular complications. B Show 8 more As per CCS 2016 guidelines: Initiate, maintain, or augment antihypertensive therapy in patients with preexisting hypertension or patients developing hypertension related to cancer therapy. A Set a target BP of < 140/90 mmHg in all patients without diabetes. Adjust the BP target to < 130/80 mmHg in patients with diabetes. A Management of QTc prolongation: As per ESC 2022 guidelines, discontinue QTc-prolonging cancer therapy in patients developing Torsade de pointes or sustained ventricular tachyarrhythmias during treatment. B Show 7 more As per CCS 2016 guidelines, identify and correct metabolic and electrolyte disturbances in patients with a QTc interval > 500 ms during treatment. Minimize the use of concomitant QT- prolonging drugs where possible. B Management of atrial fibrillation: consider using the CHA2DS2-VASc score for risk stratification for stroke/systemic thromboembolism, recognizing that it may underestimate the actual thromboembolic risk. C Show 9 more Management of acute coronary syndrome: As per ESC 2022 guidelines, use an invasive strategy in patients with cancer presenting with STEMI or high-risk non-ST-elevation acute coronary syndrome with a life expectancy 6 months. B Show 6 more As per CCS 2016 guidelines, consider switching to an alternative antineoplastic treatment if patients experience myocardial ischemia due to the cancer therapy. C Management of heart failure: evaluate and manage patients with cancer developing clinical HF or an asymptomatic decline in LVEF (such as > 10% decrease in LVEF from baseline or LVEF < https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 3/12 6/29/23, 3:44 AM Cardiotoxicity of cancer therapy Pathway 53%) during or after treatment according to current published guidelines. Exclude other causes of LV dysfunction. A Management of Takotsubo syndrome: obtain coronary angiography (invasive or coronary CT angiography) to exclude acute coronary syndromes. B Show 2 more Management of late cardiac dysfunction: initiate ACEIs/ARBs and/or -blockers in adult cancer survivors with moderate asymptomatic cancer therapy-related cardiac dysfunction. B Show 2 more Management of pericarditis: diagnose and manage acute pericarditis in patients with cancer according to current published guidelines for the diagnosis and management of pericardial diseases. Arrange a multidisciplinary discussion before interrupting cancer therapy. B Show 4 more Management of valvular heart disease: manage patients with cancer and preexisting severe VHD or new VHD developed during cancer therapy according to current published guidelines for the management of VHD, taking cancer prognosis, patient comorbidities, and patient preferences into consideration. B Show 2 more Management of carcinoid heart disease: obtain echocardiography for the detection of carcinoid cardiac involvement in all patients with carcinoid syndrome and elevated natriuretic peptide levels and/or clinical signs of carcinoid heart disease, and for surveillance every 3-6 months depending on the severity of cardiac involvement and clinical status. B Consider obtaining natriuretic peptides for screening and surveillance of carcinoid heart disease every 6 months. B Show 4 more Management of cardiac amyloidosis: obtain echocardiography, natriuretic peptides, and cardiac troponin for the diagnosis of amyloid light-chain cardiac amyloidosis in patients with plasma cell dyscrasia. B Show 5 more Management of venous thromboembolism: initiate apixaban, edoxaban, or rivaroxaban for the treatment of symptomatic or incidental VTE in patients with cancer without contraindications. A Show 5 more Management of peripheral artery disease: Ensure a multidisciplinary approach regarding the decision to continue versus interrupt culprit cancer therapy in patients developing new symptomatic PAD. B Optimize cardiovascular follow-up and treatment in patients with vascular toxicities during cancer therapy. B 4. Nonpharmacologic interventions Lifestyle modifications: https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 4/12 6/29/23, 3:44 AM Cardiotoxicity of cancer therapy Pathway Encourage exercising on a regular basis in patients receiving anticancer therapy and long-term cancer survivors. B Advise adopting healthy dietary habits (high intake of fresh fruits/vegetables and whole grains as compared with refined grains, processed and red meats, and high-fat foods) and maintaining a normal weight in patients receiving anticancer therapy and long-term cancer survivors. B Cardiac rehabilitation: consider offering targeted cardiac rehabilitation in cancer survivors with high cardiovascular risk. C 5. Specific circumstances Pregnant patients: provide pre-pregnancy counseling and management during pregnancy and around delivery in high-risk female cancer survivors by a multidisciplinary pregnancy heart team. B Show 8 more Patients receiving anthracyclines, evaluation: As per IC-OS/ESTRO/EHA/ESC 2022 guidelines, obtain baseline echocardiography in all patients with cancer before initiating anthracycline chemotherapy. B Show 8 more As per ESMO 2020 guidelines, obtain periodic measurement (every 3-6 weeks or before each cycle) of troponin I or troponin T, BNP or N-terminal pro-BNP for risk stratification and early detection of cardiac toxicity in asymptomatic patients with normal LVEF receiving anthracycline therapy. B Show 3 more Patients receiving anthracyclines, prevention of cardiotoxicity: As per IC-OS/ESTRO/EHA/ESC 2022 guidelines: Consider initiating liposomal anthracyclines or dexrazoxane in adult patients with cancer at high or very high cardiovascular toxicity risk when anthracycline chemotherapy is indicated. C Initiate ACEIs/ARBs and -blockers for primary prevention in high- and very high-risk patients receiving anthracyclines. B As per ESMO 2020 guidelines: Offer dexrazoxane as a primary prevention cardioprotection in selected patients receiving > 300 mg/m anthracycline-based chemotherapy, though not widely used due to its potential risk of reducing the efficacy of anthracyclines. B Consider administering dexrazoxane concomitantly from the beginning of anthracycline therapy in patients with preexisting cardiomyopathy requiring anthracycline-based chemotherapy, regardless of the type of cancer. B Do not use anthracycline therapy in particular in patients with an LVEF < 40% unless there are no effective alternative anticancer treatment options. D https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 5/12 6/29/23, 3:44 AM Cardiotoxicity of cancer therapy Pathway Patients receiving anthracyclines (management of asymptomatic cardiac dysfunction): interrupt anthracycline chemotherapy temporarily and initiate HF therapy in patients developing asymptomatic moderate or severe cancer therapy-related cardiac dysfunction. B Show 3 more Patients receiving anthracyclines, management of symptomatic cardiac dysfunction: As per IC-OS/ESTRO/EHA/ESC 2022 guidelines, initiate HF therapy in patients developing symptomatic cancer therapy-related cardiac dysfunction during anthracycline chemotherapy. B Show 3 more As per ESMO 2020 guidelines, continue cardiovascular care indefinitely including medical treatment with ACEIs, ARBs, and/or -blockers and regular cardiology review (annual if asymptomatic) in patients with LV dysfunction or HF due to anthracyclines, regardless of improvement in LVEF or symptoms. Decide on withdrawing HF-based therapy only after a period of stability, no active cardiac risk factors, and no further active anticancer therapy. B Patients receiving anthracyclines (restarting anthracyclines): consider initiating liposomal anthracycline or dexrazoxane to reduce the risk of further cardiovascular toxicity in patients with moderate or severe symptomatic or asymptomatic cancer therapy-related cardiac dysfunction requiring further anthracycline chemotherapy. C Patients receiving anti-HER2 therapies, evaluation: As per IC-OS/ESTRO/EHA/ESC 2022 guidelines, obtain baseline echocardiography in all patients before initiating HER2-targeted therapies. B Show 9 more As per ESMO 2020 guidelines, obtain general surveillance for cardiovascular toxicity with periodic cardiac physical examination, cardiac biomarkers, and/or cardiac imaging in asymptomatic patients undergoing anti-HER2-based treatment of metastatic disease. B Show 5 more Patients receiving anti-HER2 therapies, prevention of cardiotoxicity: As per IC-OS/ESTRO/EHA/ESC 2022 guidelines, initiate ACEIs/ARBs and -blockers for primary prevention in high- and very high-risk patients receiving anti-HER2 therapies. B As per ESMO 2020 guidelines, consider initiating cardioprotective treatments (ACEIs, ARBs, and/or -blockers), if not already prescribed, in symptomatic patients undergoing treatment with trastuzumab and with an LVEF decrease of 10% from baseline or a decrease in LVEF to 40% but < 50%. B Patients receiving anti-HER2 therapies (management of asymptomatic cardiac dysfunction): interrupt HER2-targeted therapy temporarily and initiate HF therapy in patients developing asymptomatic severe cancer therapy-related cardiac dysfunction. B Show 6 more Patients receiving anti-HER2 therapies (management of symptomatic cardiac dysfunction): initiate HF therapy in patients developing symptomatic moderate-to-severe cancer therapy-related cardiac dysfunction with LVEF < 50% during human epidermal receptor 2-targeted treatment. B Show 2 more https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 6/12 6/29/23, 3:44 AM Cardiotoxicity of cancer therapy Pathway Patients receiving anti-HER2 therapies (restarting anti-HER2 therapies): Consider resuming trastuzumab (or any HER2-targeted molecular therapy) in patients with LVEF 40% and/or if signs and symptoms of HF have resolved, supported by continued medical therapy for HF and ongoing cardiology care, periodic cardiac biomarker assessments, and periodic LVEF assessments during ongoing treatment. C Consider resuming trastuzumab (or any HER2-targeted molecular therapy) if no alternative therapeutic option exists in patients with non-resolving signs and symptoms of HF and/or persisting LVEF < 40%. Discuss the risk-benefit assessment of prognosis from cancer versus HF with the multidisciplinary team and the patient. C Patients receiving fluoropyrimidines: obtain baseline cardiovascular risk assessment and evaluation including BP measurement, ECG, lipid profile, HbA1c measurement, and SCORE2/SCORE2-Older Persons or equivalent before initiating fluoropyrimidines. B Show 2 more Patients receiving VEGF inhibitors: As per ESC 2022 guidelines, measure BP at every clinical visit in patients treated with VEGF inhibitors, bevacizumab, or ramucirumab. B Show 7 more As per ESMO 2020 guidelines: Obtain a baseline BP measurement and serial BP monitoring along with surveillance for early detection of cardiovascular toxicity consisting of periodic cardiac physical examination, cardiac biomarkers, and/or cardiac imaging in patients receiving cancer therapeutics associated with a risk of systemic hypertension, especially anti-VEGF-based therapy. A Assess and optimize BP control and consider measuring LVEF and/or cardiac biomarkers in patients undergoing treatment with sunitinib (or other anti-VEGF-based therapy) showing signs and symptoms of HF. Interrupt sunitinib (or other anti-VEGF-based therapies) and later assess to determine whether reinstituting those therapies is appropriate. B Patients receiving Bcr-Abl tyrosine kinase inhibitors (evaluation): obtain baseline cardiovascular risk assessment in patients requiring second- or third-generation Bcr-Abl TKIs. B Show 7 more Patients receiving Bcr-Abl tyrosine kinase inhibitors (management of pulmonary hypertension): discontinue dasatinib and perform right heart catheterization in patients developing symptomatic or asymptomatic increase in peak tricuspid regurgitation velocity > 3.4 m/s. B Show 2 more Patients receiving Bruton's tyrosine kinase inhibitors: obtain BP measurements at every clinical visit in patients treated with Bruton's TKIs. B Show 4 more Patients receiving multiple myeloma therapies (evaluation): obtain BP measurement at every clinical visit in patients treated with proteasome inhibitors. B Show 8 more https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 7/12 6/29/23, 3:44 AM Cardiotoxicity of cancer therapy Pathway Patients receiving multiple myeloma therapies (VTE prophylaxis): initiate therapeutic doses of LMWH in patients with multiple myeloma with previous VTE. B Show 3 more Patients receiving RAF/MEK inhibitors: obtain BP monitoring at each clinical visit and weekly outpatient monitoring during the first 3 months of treatment and monthly thereafter. B Show 4 more Patients receiving immune checkpoint inhibitors, evaluation: As per IC-OS/ESTRO/EHA/ESC 2022 guidelines, obtain ECG, natriuretic peptides, and cardiac troponin measurements in all patients before initiating immune checkpoint inhibitor therapy. B Show 4 more As per ESMO 2022 guidelines, admit patients with suspected immune-related myocarditis to level 2 or 3 care with ECG monitoring and resuscitation facilities. B Show 3 more As per ESMO 2020 guidelines: Obtain further appropriate work-up (ECG, troponin, BNP or N-terminal pro-BNP, CRP, viral titer, echocardiogram with global longitudinal strain, cardiac MRI) for immune checkpoint inhibitor-associated cardiovascular toxicity, particularly myocarditis and other common differential diagnoses, in patients developing new cardiovascular symptoms or with incidentally detected arrhythmia, conduction abnormality on ECG, or LV systolic dysfunction on echocardiogram, while undergoing (or after recent completion) of immune checkpoint inhibitor therapy. B Consider performing an endomyocardial biopsy for diagnostic confirmation if the diagnosis is highly suspected with otherwise negative work-up. C Patients receiving immune checkpoint inhibitors, management: As per IC-OS/ESTRO/EHA/ESC 2022 guidelines, obtain cardiac troponin, ECG, and cardiovascular imaging (echocardiography and cardiac MRI) to diagnose immune checkpoint inhibitor-associated myocarditis. B Show 10 more As per ESMO 2022 guidelines, interrupt immune checkpoint inhibitor therapy in patients with immune-related cardiovascular toxicities and discontinue permanently in most cases of confirmed immune-related myocarditis. B Show 6 more As per ESMO 2020 guidelines, withhold further therapy with immune checkpoint inhibitors and initiate high-dose corticosteroids (methylprednisolone 1,000 mg/day, followed by oral prednisone 1 mg/kg/day) promptly in patients with either suspected or confirmed immune checkpoint inhibitor-associated myocarditis. Continue corticosteroids until resolution of symptoms and normalization of troponin, LV systolic function, and conduction abnormalities. B Show 4 more Patients receiving CDK4/6 inhibitors: obtain QTc monitoring at baseline and 14 and 28 days in all patients with cancer receiving ribociclib. A https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 8/12 6/29/23, 3:44 AM Cardiotoxicity of cancer therapy Pathway Show 2 more Patients receiving ALK/EGFR inhibitors: obtain baseline cardiovascular risk assessment in patients before initiating ALK inhibitors and epidermal growth factor receptor inhibitors. B Show 5 more Patients receiving CAR T-cell/TIL therapies: obtain baseline ECG, natriuretic peptides, and cardiac troponin in all patients with cancer before initiating chimeric antigen receptor T-cell and tumor-infiltrating lymphocytes therapies. B Show 2 more Patients receiving endocrine therapy: obtain baseline cardiovascular risk assessment and estimation of 10-year fatal and non-fatal CVD risk with SCORE2 or SCORE2-Older Persons in patients with breast cancer receiving endocrine therapies without preexisting CVD. B Show 2 more Patients receiving androgen deprivation therapy: obtain baseline cardiovascular risk assessment and estimation of 10-year fatal and non-fatal CVD risk with SCORE2 or SCORE2- Older Persons in patients treated with androgen deprivation therapy without preexisting CVD. B Show 3 more Patients receiving radiotherapy (minimization of radiation exposure): consider using modern radiotherapy techniques (such as 3D conformal radiotherapy and intensity-modulated radiotherapy) during planning mediastinal and chest radiation to reduce the risk of short- and long- term cardiotoxicity. C Patients receiving radiotherapy (evaluation): Obtain baseline cardiovascular risk assessment and estimation of 10-year fatal and non-fatal CVD risk with SCORE2 or SCORE2-Older Persons. B Consider obtaining baseline echocardiography in patients with previous CVD before administering radiotherapy to a volume including the heart. C Patients receiving radiotherapy (considerations for implanted cardiac devices): obtain risk stratification including planned radiation type and energy, dose to the cardiac implantable electronic device, the device type, and pacing dependence before initiating cancer treatment. B Show 2 more Patients receiving radiotherapy (management of pericarditis): consider obtaining echocardiography surveillance every 5 years in patients after acute pericarditis developed during radiotherapy to a volume including the heart, as these patients are at higher risk of developing chronic constrictive pericarditis. C Patients receiving radiotherapy (management of coronary artery disease): obtain noninvasive stress testing to guide ischemia-directed management in asymptomatic cancer survivors with new moderate or severe radiation-induced coronary artery disease detected on coronary CT angiography. B Show 3 more Patients receiving radiotherapy (management of valvular heart disease): consider performing TAVI in patients with symptomatic severe aortic stenosis caused by radiation at intermediate https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 9/12 6/29/23, 3:44 AM Cardiotoxicity of cancer therapy Pathway surgical risk. C Patients receiving radiotherapy (surveillance): assess for coronary artery disease, ischemia, and valvular disease in patients with a history of mediastinal chest radiotherapy, even if asymptomatic, starting at 5 years post-treatment and at least every 3-5 years thereafter. A Patients receiving HCST: Obtain baseline and serial cardiovascular risk assessment (3 and 12 months, then yearly) including BP measurement, ECG, lipid measurement, and HbA1c in HSCT recipients. B Obtain echocardiography in all patients before HSCT. B Consider obtaining baseline natriuretic peptides measurement before HSCT. B 6. Patient education General counseling: Provide education and support for making appropriate healthy lifestyle choices in patients with cancer. B Educate patients with cancer regarding the recognition of early signs and symptoms of CVD. B 7. Preventative measures Primary prevention: As per ESC 2022 guidelines, manage cardiovascular risk factors before, during, and after cancer therapy according to current published guidelines on CVD prevention. B Show 2 more As per ESMO 2020 guidelines, consider initiating prophylactic ACEIs or ARBs (if intolerant to ACEIs) and/or selected -blockers in patients with a normal LVEF and cardiovascular risk factors scheduled to undergo anticancer therapy with known cardiotoxic agents, particularly in patients exposed to multiple cardiotoxic agents. C Show 3 more As per CCS 2016 guidelines: Assess traditional cardiovascular risk factors and ensure optimal treatment of CVD according to current published guidelines in all patients before, during, and after receiving cancer therapy. B Consider initiating ACEIs/ARB, -blockers, and/or statins to reduce the risk of cardiotoxicity in patients at high risk for cancer treatment-related LV dysfunction. C Thromboprophylaxis: administer extended prophylaxis with LMWH for 4 weeks postoperatively in patients with cancer undergoing major open or laparoscopic abdominal or pelvic surgery with low bleeding risk and high VTE risk. B Show 3 more https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 10/12 6/29/23, 3:44 AM Cardiotoxicity of cancer therapy Pathway 8. Follow-up and surveillance Indications for referral: As per ESMO 2020 guidelines, ensure close and early collaboration between cardiologists, oncologists, hematologists, and radiation oncologists to ensure lifelong cardiovascular health and to avoid unnecessary discontinuation of cancer therapy. B Show 2 more As per CCS 2016 guidelines, consider referring patients at high risk of cancer therapy-related CVD or patients developing cardiovascular complications during cancer therapy (such as > 10% decrease in LVEF from baseline or LVEF < 53%) to a cardio-oncology clinic or specialist skilled in the management of this patient population, for optimization of cardiac function and consideration of primary or secondary prevention strategies. C Indications for referral (ECS): refer high- and very high-risk patients to a cardiologist before initiating anticancer therapy. B Show 4 more Post-cancer therapy assessment: assess cardiovascular risk factors during the first year after cancer therapy and thereafter according to current published guidelines on CVD prevention. B Show 3 more Cardiovascular surveillance (asymptomatic childhood/adolescent cancer survivors): educate adult survivors of childhood or adolescent cancer treated with anthracyclines, mitoxantrone, and/or radiotherapy to a volume including the heart regarding their increased cardiovascular risk. B Obtain annual screening for modifiable cardiovascular risk factors. B Show 2 more Cardiovascular surveillance, asymptomatic adult cancer survivors: As per IC-OS/ESTRO/EHA/ESC 2022 guidelines, obtain annual cardiovascular risk assessment, including ECG and natriuretic peptides, and initiate cardiovascular risk factor management in cancer survivors treated with a potentially cardiotoxic cancer drug or radiotherapy. B Show 7 more As per ESMO 2020 guidelines, consider obtaining periodic screening for the development of new asymptomatic LV dysfunction with cardiac biomarkers and potentially cardiac imaging at 6- 12 months, at 2 years post-treatment, and possibly periodically thereafter in asymptomatic patients treated with cardiotoxic agents and having a normal cardiac function. C Show 2 more Clinical findings Past medical history Social history Acute coronary syndrome Alcohol consumption Coronary artery disease Tobacco use https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 11/12 6/29/23, 3:44 AM Cardiotoxicity of cancer therapy Pathway Dilated cardiomyopathy Cardiac exam Dyslipidemia Pericardial rub Exposure to chemotherapy Pericarditis Exposure to radiation therapy HF Imaging findings Hypertension Hypertrophic cardiomyopathy Pericardial effusion Malignancy LVEF Myocarditis Obesity PAD VHD Vital signs Bradycardia Hypertension ECG findings AF AV block Prolonged QTc interval Sinus tachycardia Supraventricular arrhythmia VF Ventricular arrhythmia References 1. G Curigliano, D Lenihan, M Fradley et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol. 2020 Feb;31 2 171 190. Open 2. Alexander R Lyon, Teresa L pez-Fern ndez, Liam S Couch et al. 2022 ESC Guidelines on cardio- oncology developed in collaboration with the European Hematology Association EHA , the European Society for Therapeutic Radiology and Oncology ESTRO and the International Cardio-Oncology Society IC OS . Eur Heart J Cardiovasc Imaging. 2022 Sep 10;23 10):e333-e465. Open 3. Sean A Virani, Susan Dent, Christine Brezden-Masley et al. Canadian Cardiovascular Society Guidelines for Evaluation and Management of Cardiovascular Complications of Cancer Therapy. Can J Cardiol. 2016 Jul;32 7 831 41. Open 4. J Haanen, M Obeid, L Spain et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Dec;33 12 1217 1238. Open 5. Saro H Armenian, Christina Lacchetti, Ana Barac et al. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2017 Mar 10;35 8 893 911. Open https://web.pathway.md/diseases/recsrrNZ3YwPatuW5 12/12