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Cardiotoxicity — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesCardiotoxicitySCE Medical Oncology

A 58-year-old man receiving R-CHOP for diffuse large B-cell lymphoma develops sudden onset chest pain and acute ST elevation on ECG during his doxorubicin infusion. Troponin is elevated. LVEF was normal before treatment. What is the most likely cause?

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Correct answer: A — Doxorubicin-induced acute cardiotoxicity

Doxorubicin can cause both acute and chronic cardiotoxicity. Acute cardiotoxicity (during or within hours of infusion) can manifest as arrhythmias, myocarditis, or acute heart failure. It is distinct from the chronic dose-dependent cardiomyopathy (typically >450 mg/m² cumulative dose). Acute events can include troponin elevation and ECG changes. Management includes stopping the infusion, supportive cardiac care, and reassessment of the risk-benefit of further anthracycline use. Dexrazoxane may be considered for future cycles if anthracycline continuation is essential.

Reference: BNF Doxorubicin monograph; ESMO 2024 Cardio-Oncology Guidelines