Modern treatment strategies have led to improvements in cancer survival, however, these gains might be offset by the potential negative effect of cancer therapy on cardiovascular health. Cardiotoxicity is now recognized as a leading cause of long-term morbidity and mortality among cancer survivors. This guideline, authored by a pan-Canadian expert group of health care providers and commissioned by the Canadian Cardiovascular Society, is intended to guide the care of cancer patients with established cardiovascular disease or those at risk of experiencing toxicities related to cancer treatment. It includes recommendations and important management considerations with a focus on 4 main areas: identification of the high-risk population for cardiotoxicity, detection and prevention of cardiotoxicity, treatment of cardiotoxicity, and a multidisciplinary approach to cardio-oncology. All recommendations align with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Key recommendations for which the panel provides a strong level of evidence include: (1) that routine evaluation of traditional cardiovascular risk factors and optimal treatment of preexisting cardiovascular disease be performed in all patients before, during, and after receiving cancer therapy; (2) that initiation, maintenance, and/or augmentation of antihypertensive therapy be instituted per the Canadian Hypertension Educational Program guidelines for patients with preexisting hypertension or for those who experience hypertension related to cancer therapy; and (3) that investigation and management follow current Canadian Cardiovascular Society heart failure guidelines for cancer patients who develop clinical heart failure or an asymptomatic decline in left ventricular ejection fraction during or after cancer treatment. This guideline provides guidance to clinicians on contemporary best practices for the cardiovascular care of cancer patients.

The pyrolysis of vinyl bromide has been examined in the temperature range 637−733 K and at pressures from 6 to 86 kPa. The yields of the major hydrocarbon products, C2H2, C2H4, and 1,3-C4H6, are second order in vinyl bromide over the entire range of temperatures investigated. At the higher temperatures, initiation by molecular elimination of HBr dominates, while at lower temperatures a free radical initiation channel becomes increasingly important. Our data for the overall process leading to HBr fit the relation ln(k) = (30.7 ± 4.8) − ((26.6 ± 3.3) × 103)/T, with the rate constant in the units L mol-1 s-1, indicating an activation energy of 220 kJ mol-1 ± 12% for the HBr elimination. A simple Arrhenius extrapolation is close to previous results at temperatures from 800 to over 2000 K. The combination of our data and the earlier measurements of the HBr elimination is reasonably represented by ln(k) = 37 − (3 × 104)/T. Our data suggest that the free radical pathway is disproportionation rather than unimolecular cleavage of the C−Br bond, a situation analogous to that in the low-temperature thermal decomposition of ethylene. Kinetic analysis indicates that the activation energy of this new free radical initiation channel is approximately 150 kJ mol-1, much less than the C−Br bond energy.

A comprehensive examination with knowledge of the potential limitations of echocardiography is required to accurately interpret LV systolic and diastolic function in patients with suspected HFNEF.

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