Coronary Artery Dsease

Many cancer patients also have coronary artery disease. Anemia from bone marrow suppression or malignant infiltration can result in decreased myocardial oxygen supply. Interferon and interleukin 2 (IL-2) can increase cardiac output, resulting in an increased myocardial oxygen demand. Several chemotherapeutic agents have been associated with cardiac ischemia, including 5-fluorouracil, vinblastine, and IL-2. Sternal pain mimicking angina has been associated with GM-CSF.

Many agents have been associated with tachyarrhythmias, bradyarrhythmias, and atrioventricular conduction blocks. These include the anthracyclines, 5-fluorouracil, interferon, IL-2, GM-CSF, and paclitaxel. Myocarditis has been reported in association with anthracyclines and cyclophosphamide. Anthracyclines are directly toxic to myocardial cells, while cyclophosphamide toxicity appears to be vascular. Anthracycline-induced cardiomyopathy may occur months to years after cessation of treatment and is related to the total cumulative dose. It is irreversible. It is evaluated and managed in the same manner as any dilated, congestive cardiomyopathy.

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