Arrhythmias in cancer patients

Cardiac dysrhythmias are common in cancer patients. Recognition and management of dysrhythmias requires an understanding of common etiologies seen in the cancer population. These may include cancer involvement of the myocardium or various cancer treatments including chemotherapy, radiation, and surgery. They can also be due to other underlying comorbidities such as preexisting cardiovascular disease, electrolyte derangements, or hormonal abnormalities. Clinical recognition of dysrhythmias can be challenging as they can present incidentally in an asymptomatic patient. When symptomatic, patients may present with palpitations, dizziness, syncope, or cardiac arrest. The diagnosis is often made through rhythm interpretation on a 12-lead ECG, Holter monitor, or bedside cardiac monitor. Acute management of cardiac rhythm disorders includes urgent patient stabilization and discontinuation of offending agents. Treatment for the arrhythmias and conduction abnormalities may require the use of antiarrhythmic medications, electrical cardioversion, pacemaker placement, and need for anticoagulation in high-risk patients. Cardiac interventionsmay often conflict with cancer treatment such as in the case of magnetic resonance imaging in patients with pacemakers and anticoagulation in patients with thrombocytopenia. Reconciliation of these complex decisions requires a multidisciplinary approach with understanding of both the cardiovascular and oncologic risks.