Review Question - QID 103005

This patient will soon initiate cytotoxic chemotherapy with a regimen that includes doxorubicin. This medication can cause heart failure at high cumulative doses and cardiac function should be monitored with echocardiography.

Doxorubicin is a commonly used chemotherapeutic agent in the anthracycline class of medications, which works through inhibition of topoisomerase. As patients receive cumulative doses of these medications, there is dose-related risk for developing a cardiomyopathy, thought to be through generation of free radicals. Clinicians are mandated to serially evaluate this through the use of echocardiography which can assess the patient's cardiac function and ejection fraction and monitor for signs of cardiac toxicity.

Incorrect Answers:
Answer 1: Cardiac MRI is an increasingly powerful tool for imaging cardiac function, but it is not yet routinely performed in the context of cardiotoxic chemotherapy.

Answer 2: Chest radiograph can demonstrate cardiomegaly, but it is not sensitive enough for detecting changes in ejection fraction and would not demonstrate any changes until very late stage complications with severe heart failure.

Answer 3: ECG is a non-specific modality that could assess for changes in the cardiac conduction system; however, changes in the conduction system that would manifest on ECG would not typically take place until more severe disease is present.

Answer 5: No regular monitoring indicated is inappropriate as doxorubicin is cardiotoxic and monitoring of cardiac function is indicated.

Bullet Summary:
Administration of cardiotoxic chemotherapeutic agents such as doxorubicin warrant monitoring of cardiac function with echocardiography.