Patient handout

Cardio-oncology cardiotoxicity surveillance & management (chronic, cross-system)

PRODUCTION

1. Your condition

This handout is for cardio-oncology cardiotoxicity surveillance & management (chronic, cross-system). Your care team identified this based on: pre-treatment baseline before anthracycline/her2/vegf/ici/rt.

Other reasons your team may use this plan: asymptomatic lvef / gls decline during cancer therapy; rising troponin / natriuretic peptide on cardiotoxic regimen; new hf symptoms during/after cancer therapy.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
HFA-ICOS baseline risk stratification + baseline/serial GLS-echo + troponin/NP surveillance	—	—	—	2022 ESC Cardio-Oncology — risk-stratified surveillance intensity; GLS relative decline + biomarkers detect subclinical CTRCD

Plan: Cardio-oncology — surveillance + cardioprotection/GDMT + agent-specific + onco-decision (2022 ESC Cardio-Oncology; 2022 AHA/ACC/HFSA HF)

3. When to call your provider

Contact your care team if any of the following happen:

Suspected ICI myocarditis → ED + acute ICI-myocarditis pathway — 2022 ESC Cardio-Oncology
Severe CTRCD → multidisciplinary interrupt decision + the four foundational heart-failure medications — 2022 ESC Cardio-Oncology
Uncontrolled VEGF-TKI HTN → intensify (avoid stopping oncotherapy if possible) — 2022 ESC Cardio-Oncology

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Suspected immune-checkpoint-inhibitor myocarditis (troponin rise + symptoms/arrhythmia/conduction) — fulminant, high mortality: HOLD ICI + high-dose corticosteroids — EMERGENCY (route acute) — 2022 ESC Cardio-Oncology(life-threatening)
CTRCD detected (GLS relative decline ≥15% / heart pumping strength (LVEF) drop / biomarker rise) — grade (mild/moderate/severe), cardioprotection/the four foundational heart-failure medications, multidisciplinary continue-vs-interrupt — 2022 ESC Cardio-Oncology
High cumulative anthracycline / high baseline risk — dexrazoxane + intensified GLS surveillance; lifelong survivorship surveillance — 2022 ESC Cardio-Oncology
BTK-inhibitor-associated AF — rate/rhythm + anticoagulation with cancer-bleeding awareness (BTKi increase bleeding; avoid warfarin; DOAC/interaction-aware) — 2022 ESC Cardio-Oncology
Prior thoracic radiation — late multi-territory RIHD (CAD, valve, pericardium, conduction, restrictive) — lifelong multi-domain surveillance — 2022 ESC Cardio-Oncology
Pregnancy during/after cardiotoxic therapy — avoid ACEi/ARB/ARNi/SGLT2i in pregnancy (BB ± hydralazine); peripartum CTRCD risk; cardio-obstetric + oncology — ESC 2018 Pregnancy

5. Follow-up

Survivorship lifelong surveillance (anthracycline/RT/childhood-cancer); re-phenotype if HF persists

6. Sources

Guideline: 2022 ESC Cardio-Oncology Guideline (Lyon) + 2022 AHA/ACC/HFSA HF Guideline