When should a patient who is starting doxorubicin receive an echocardiogram?
a) Prior to starting therapy
b) After initiation of therapy
c) Following completion of therapy
d) If the patient develops symptoms
e) All of the above
Answer e. As discussed above, serial echocardiography is important for patients receiving (or those with a history of receiving) anthracyclines, including doxorubicin. Importantly, systolic function may appear normal in some patients but myocardial depressant medications (including most anesthetics) may unmask significant dysfunction. Therefore a high index of suspicion for dysfunction is always warranted in these patients.