Palpitations in the Cancer Patient

Abstract

Cancer and cardiovascular diseases (CVD) are among the leading causes of death worldwide. In response to the growing population of cancer patients and survivors with CVD, the sub-specialty of cardio-oncology has been developed to better optimise their care. Palpitations are one of the most common presenting complaints seen in the emergency room or by the primary care provider or cardiologist. Palpitations are defined as a rapid pulsation or abnormally rapid or irregular beating of the heart and present a complex diagnostic entity with no evidence-based guidelines currently available. Palpitations are a frequent occurrence in people with cancer, and investigations and treatment are comparable to that in the general population although there are some nuances. Cancer patients are at a higher risk of arrhythmogenic causes of palpitations and non-arrhythmogenic causes of palpitations. This review will appraise the literature with regards to the development and management of palpitations in the cancer patient.

A Pilot Study of Associations Between the Occurrence of Palpitations and Cytokine Gene Variations in Women Prior to Breast Cancer Surgery

“…Limitations of this pilot study include the lack of detailed information on cardiac history; menopausal status; and characterization of palpitations (e.g., frequency, aggravating and relieving factors, impact). Given its cross-sectional design, future studies need to evaluate for changes in the occurrence and characteristics of palpitations, particularly as these women with breast cancer receive radiation therapy (Yan et al, 2022), adjuvant endocrine therapy (Choo et al, 2019; Kyvernitakis et al, 2014), and/or cardiotoxic chemotherapy (Croft et al, 2019; Essa & Lip, 2021; Essa et al, 2021).…”

“…Progress in the treatments for cancer and cardiovascular disease has resulted in a growing population of patients with both chronic conditions. In fact, cardiovascular disease is the second most common cause of morbidity and mortality in oncology patients following recurrence of cancer (Essa & Lip, 2021; Essa & Lip, 2021). With the emergence of the specialty of cardio-oncology, a number of reviews have summarized the common causes of palpitations in oncology patients (Ala et al, 2019; Bansal et al, 2019; Essa & Lip, 2021; Essa et al, 2021).…”

“…In fact, cardiovascular disease is the second most common cause of morbidity and mortality in oncology patients following recurrence of cancer (Essa & Lip, 2021; Essa & Lip, 2021). With the emergence of the specialty of cardio-oncology, a number of reviews have summarized the common causes of palpitations in oncology patients (Ala et al, 2019; Bansal et al, 2019; Essa & Lip, 2021; Essa et al, 2021). Similar to the general population, common causes of palpitations include: various types of cardiac arrhythmias (e.g., atrial fibrillation, sinus tachycardia, supraventricular tachycardia); anxiety disorders (e.g., generalized anxiety disorder, panic attacks); miscellaneous causes (e.g., caffeine, alcohol, thyroid disorders, electrolyte imbalances); and cancer-specific causes (e.g., chemotherapy, cardiac myomas).…”

Cardio-oncology in 2022

“…As stated by Essa et al, patients with cancer are more likely to suffer palpitations due to cardiotoxicity, the underlying cancer and/or anxiety and stress. 4 Several chemotherapeutic drugs are associated with arrhythmias including ibrutinib, which is used in the treatment of a variety of B-cell lymphomas, and arsenic, used to treat some leukaemias and myelomas. Palpitations occurring in patients treated with these agents should prompt a thorough search for an arrhythmia with early involvement of the cardiooncology team.…”