Side effects of systemic cancer therapy - cardiomyopathy
Patterns
- Cancer therapy-related cardiac dysfunction (CTRCD) - the umbrella term
- Two classical patterns, with a third emerging
| Type I (anthracycline) | Type II (trastuzumab) | |
|---|---|---|
| Mechanism | Myocyte death | Reversible HER2 blockade |
| Dose-related | Yes - cumulative | No |
| Reversibility | Largely irreversible | Largely reversible on cessation |
| Biopsy | Vacuolisation, myofibrillar loss | Little structural change |
| Re-challenge | No | Yes, once EF recovers |
- Emerging: checkpoint inhibitor myocarditis - rare (~1%) but fatality up to 50%; a fulminant inflammatory rather than degenerative process
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