Cardiac Manifestations of Cancer and Their Management

While primary cardiac cancer is rare, secondary malignancy can impact the heart directly or indirectly, often with dramatic consequences. Direct involvement of the endocardium or myocardium can lead to conduction disturbances, or failure of myocardial contractility; involvement of the pericardium can lead to pericardial effusion and tamponade and, less commonly, pericarditis. Tumors can also exert their effect indirectly, as a result of vasoactive substances produced by the cancer, such as carcinoid, deposition of proteinaceous materials in case of cardiac amyloid, or through distant mechanical impact on circulation, as in the case of cor pulmonale or SVC thrombosis with a consequent hemodynamic effect on the heart. The most appropriate therapy is best delivered in a multidisciplinary setting, depends on the primary cancer and its responsiveness to anticancer therapy, and should be influenced by the overall prognosis, goals of treatment, functional status, and comorbidities.