cardiotoxikus

Cardiotoxikus, also spelled cardiotoxic, is an umbrella term for substances or conditions that impair the structure or function of the heart. It can result from exposure to certain medications, chemicals, or radiation, as well as metabolic or systemic diseases. Cardiotoxicity can affect cardiac muscle (myocardium), the heart’s electrical conduction system, or coronary vessels, leading to cardiomyopathy, arrhythmias, ischemia, or heart failure. The onset can be acute or delayed, ranging from hours to years after exposure.

Common sources include cancer chemotherapy agents such as anthracyclines (eg, doxorubicin, daunorubicin) and targeted therapies (eg, trastuzumab), as well as radiation therapy to the chest. Other cardiotoxins include alcohol, cocaine, methamphetamine, and certain heavy metals or environmental toxins. The risk is influenced by cumulative dose, age, preexisting cardiovascular disease, concomitant therapies, and genetic predispositions.

Pathophysiology varies by agent but often involves oxidative stress, mitochondrial dysfunction, and interference with cardiac muscle cell survival; anthracyclines may inhibit topoisomerase II beta in cardiomyocytes. Diagnosis relies on clinical symptoms and imaging; echocardiography is commonly used to monitor left ventricular ejection fraction, supplemented by cardiac biomarkers such as troponin and natriuretic peptides, and sometimes MRI.

Prevention includes dose limits, protective agents like dexrazoxane in some regimens, and monitoring during treatment. Management focuses on treating heart failure or arrhythmias, adjusting or stopping the offending exposure, and applying standard cardiovascular therapies. Ongoing research explores early detection and mitigation of cardiotoxicity to improve long-term outcomes.