Case of Anthracycline-induced Cardiogenic Shock: A Call to Optimize Modifiable Cardiac Risk Factors Prior to Chemotherapy

Abstract

Anthracyclines, including doxorubicin, are an important class of chemotherapeutic agents. Their efficacy, however, is limited by cardiotoxicity. Risk factors for anthracycline-associated cardiotoxicity include dose, treatment-specific risk factors including adjunctive radiotherapy, patient-specific modifiable cardiac risk factors including hypertension, hyperlipidemia, diabetes mellitus, tobacco use and obesity, and patient-specific non-modifiable risk factors such as age. The reduction of treatment-specific factors is not always possible, but treatment and reduction of modifiable risk factors should always be an important aspect of the management plan and may reduce the risk of anthracycline-induced cardiotoxicity. We present the case of a 65-year-old male with multiple modifiable cardiovascular risk factors who developed cardiogenic shock shortly after the administration of combination therapy with anthracyclines for the treatment of Hodgkin’s lymphoma.

Oxidative stress and inflammation: determinants of anthracycline cardiotoxicity and possible therapeutic targets

“…Several imaging techniques allow to assess the presence and extent of inflammation and to monitor its evolution over time (Table 1 ). In the acute phase, imaging findings may vary from a subclinical injury with preserved LVEF [ 5 ] up to extensive involvement and cardiogenic shock [ 39 ]. Echocardiography represents the first-line imaging technique, but subtle systolic abnormalities may not be recognized during the early phases of the disease.…”