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Side Effect: Heart Failure

What is Heart Failure?

Heart failure (HF) is a complex clinical syndrome that is characterized by the inability of the ventricles of the heart to fill or pump blood appropriately, which decreases the amount of oxygenated blood that is delivered to the body. Heart failure is categorized by staging (A, B, C, or D) and limitations of activity based upon symptoms (New York Heart Association Classification I, II, III, or IV).

Abbreviated Overview of the 4 Stages of Heart Failure:

Stage  Definition & Criteria
Stage A: At risk of HF At risk but without symptoms, structural heart disease, or cardiac biomarkers indicating structural changes or injury
Stage B: Pre-HF  • No symptoms or signs of HF
• At least 1 of the following:
o Structural heart disease
o Evidence for increased filling pressures
o Patients with risk factors and increased levels of B-type natriuretic peptide (BNP) or persistently elevated cardiac troponin in the absences of other causes
Stage C: Symptomatic HF Structural heart disease with current or previous symptoms of HF
Stage D: Advanced HF  Marked HF symptoms that interfere with daily life and with recurrent hospitalizations despite attempts to optimize drug therapy

Abbreviated Overview of the New York Heart Association (NYHA) Classification

Symptoms Definition & Criteria
Class I No symptoms and no limitation in ordinary physical activity
Class II Mild symptoms and slight limitation during ordinary activity
Class III Marked limitation in activity due to symptoms, even during less-than-ordinary activity
Class IV  Severe limitations, with symptoms even while at rest

What does Heart Failure look like?

Symptoms of HF can vary, however common symptoms of HF include:

Diagnosing HF is complex and is based on a comprehensive clinical history, physical examination and other tests to assess for specific cardiac dysfunction:

Electrocardiogram (ECG or EKG): looks at electrical activity of the heart.

Echocardiogram (ECHO): looks at the structure and function of the heart. This test is important for determining the percentage of blood the left heart ventricle pumps out with each heart beat (also called left ventricular ejection fraction or LVEF).

Blood tests such as B-type natriuretic peptide (BNP) or NT-proBNP may be done to check for increased blood volume.

Who gets Heart Failure?

There are many risk factors for developing heart failure, these include:

Certain chemotherapy agents such as anthracyclines (example: doxorubicin (Adriamycin®), epirubicin (Ellence®), liposomal doxorubicin (Doxil®)) and anti-HER2 therapy (examples: trastuzumab (Herceptin®), pertuzumab (Perjeta®)) can cause damage to the heart muscle increasing the risk of heart failure.

How to prevent Heart Failure

How to treat Heart Failure

Treatment for heart failure is complex and may require stopping the therapy that may be causing the heart failure.

In addition to lifestyle modifications such as reducing sodium and fluid intake, one or more medications may be prescribed to treat heart failure, these medications may include:

Angiotensin-Converting Enzyme Inhibitors (ACE-I):

Angiotensin Receptor Blockers (ARBs):


Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2s):

Mineralocorticoid receptor antagonists (MRA):




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2. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American college of cardiology/American heart association joint commission on clinical practice guidelines. Circulation 2022;145:e895-e1032.

3. Piper SE, McDonagh TA. Chemotherapy-related cardiomyopathy. Euro Cardiol Rev 2015;10(1):19-24

4. Zinecard (dexrazoxane) [product monograph]. Kirkland, Quebec, Canada: Pfizer Canada ULC; April 2023.

Created: June 24, 2024 Updated: June 24, 2024