Difficult cases in heart failure: chemotherapy-related cardiomyopathy--all that glitters is not gold.

As long-term morbidity with chemotherapeutic exposure becomes a clinical reality, the development of cardiomyopathy with heart failure is rapidly growing. The type of chemotherapy agent, dose, rate of administration, use of combination chemotherapy, and concomitant radiation therapy are major factors that define the propensity to cardiotoxicity. Chemotherapy-related cardiomyopathy is multifactorial in origin and requires a diligent etiologic survey to arrive at the appropriate diagnosis. A contemporary discussion of chemotherapy-related cardiomyopathy with particular emphasis on the pathogenesis and ameliorative targets of this unique clinical disorder are described in this report.