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Anthracycline cardiotoxicity Injury may result in myocyte death; irreversible Risk factors Cumulative dose Pre existing heart disease Age young children and 65 years Mediastinal radiation Combination chemotherapy Systolic heart failure Typically months to years after exposure Individual variation genetic predisposition Cardioprotective strategies Altered anthracycline structure Epirubicin Altered delivery systems liposomal preparations Schedule modification 24 96 h continuous infusion instead of bolus Cardioprotective agents dexrazoxane Cardiac medications only single centre experience Angiotensin converting enzyme inhibitors nolvadex

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