Introduction: Cardiooncology is a recently developed (rapidly developing) field in cardiology aimed at significantly reducing cardiovascular morbidity and mortality and improving quality of life in cancer survivors. Cancer survival rates have been constantly increasing, mainly because of the advent of new, more potent and targeted therapies. However, many of the new therapies – along with some of the older chemotherapeutic regimens such as anthracyclines – are potentially cardiotoxic. Cardiotoxicity adversely affects prognosis in cancer patients, thus its prevention and treatment are crucial to improve quality and standards of care. (1)

Case report: We present a case of a young man cancer survivor who received treatment for osteosarcoma at age 18 years with a regimen that included an anthracycline. Unfortunately, he did not have routine cardiac follow-up in the survivorship period. He presented in his 40s with dyspnea. On further inquiry, he had been experiencing exertional dyspnea and poor exercise tolerance for over a decade. He was diagnosed with heart failure with a reduced left ventricular ejection fraction (LVEF of 35%). His clinical course was complicated by recurrent sustained ventricular tachycardia and defibrillator was implanted. Today he receives optimal medical treatment which includes (carvedilol, furosemid, eplerenon, sacubitril-valsartan).

Conclusion: Anthracycline cardiotoxicity most frequently presents as either early-onset chronic progressive (within the first year after completion of chemotherapy) or late-onset chronic progressive (greater than 1 year after completion of therapy) left ventricular systolic dysfunction, which is usually irreversible. Clinically, patients present with dilated cardiomyopathy. Those with late-onset chronic progressive cardiotoxicity can present as long as 1–2 decades after completion of cancer therapy. One major limitation to the use of LVEF to monitor for cardiac dysfunction is that changes in LVEF usually occur at a later stage when significant toxicity has already occurred. To minimize the risk of irreversible cardiomyopathy, the goal is to identify signs of toxicity as early as possible so medical therapy can be initiated. Today, global longitudinal strain is used in hospital for early detection of changes in cardiac contractility. In patients with anthracycline toxicity, earlier initiation of medical therapy is associated with an increased likelihood of subsequent improvement in LVEF.