Table 1.

Risk factors for cardiovascular cardiotoxicity, pathogenesis, and cardiovascular pathological manifestations caused, in regard of the method of treatment used [2, 4–6, 8, 9, 11, 14, 19–22, 30]

Therapy	Risk factors	Pathomechanism	Cardiovascular manifestation
Radiotherapy	Younger age at exposure Overall dose (> 30–35 Gy) Division into fractions (> 2 Gy) The heart was exposed to ionizing radiation (toxicity increases with increasing volume) Use of cytotoxic chemotherapy Irradiation technique (teleradiotherapy is more toxic than brachytherapy) Radiation in the morning hours (between 6 am and noon) Longer time since exposure	There are two mechanisms causing tissue damage during radiation therapy: Direct ionization of cell components Indirect radiolysis of intra-and extracellular water	Acute pericarditis 2. Chronic pericardial effusion Myocarditis Congestive heart failure Valvular stenosis 6. Regurgitation mainly of mitral and aortic valves 7. Fibrosis of the conduction system Disturbed heart rate Complete or incomplete heart block
Chemotherapy	Patient age < 18 years of age and > 65–70 years of age Overall drug dose (doxorubicin > 550 mg/m2, epirubicin > 900 mg/m2, idarubicin > 90 mg/m2) Division of the total dose into sessions Female gender (especially in the pediatric population) Manner of administration of the drug Combination of drugs administered Sequence of administration of medicines Prior or concomitant radiotherapy (in particular of left side of chest and mediastinum) Prior therapy with anthracyclines Concurrent therapy with other anti-cancer drugs (drug interaction) Hyperthermia Liver diseases Genetic peculiarities	There are two molecular mechanisms causing damage associated with: Reactive oxygen species Alcoholic metabolites	Left ventricular dysfunction Heart failure Myocarditis Arrhythmia