Cardiovascular Dysautonomia in Patients with Breast Cancer

Vera Geraldes1, 2, *, Elisa Caldeira2, Ana Afonso2, Filipa Machado2, Ângela Amaro-Leal1, 2, Sergio Laranjo1, 2, 3, Isabel Rocha1, 2
1 Instituto de Fisiologia, Faculdade de Medicina da Universidade de Lisboa, Av. Prof Egas Moniz, 1649-028, Lisbon, Portugal
2 Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Av. Prof Egas Moniz, 1649-028, Lisbon, Portugal
3 Pediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal

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© 2022 Geraldes et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Instituto de Fisiologia, Faculdade de Medicina da Universidade de Lisboa , Av. Prof Egas Moniz, Ed. Egas Moniz, piso 1, 1649-028 Lisboa, Portugal, Tel: +351 217999435; E-mail:


Breast cancer is the most frequent malignant disease among women, being responsible for a considerable percentage of fatalities and comorbidities every year. Despite advances in early detection and therapy, evidence shows that breast cancer survivors are at increased risk of developing other chronic conditions, such as cardiovascular diseases.

Autonomic dysfunction is an emerging, but poorly understood topic that has been suggested as a risk factor for cardiovascular disease in breast cancer patients. It clinically manifests through persistently elevated heart rates and abnormal heart rate variability, even before any signs of cardiovascular dysfunction appear. Since changes in the left ventricular ejection fraction only manifest when myocardial injury has already occurred, it has been hypothesized that autonomic dysfunction can constitute an early biomarker of cardiovascular impairment in breast cancer patients.

This review focuses on the direct and indirect effects of cancer and its treatment on the autonomic nervous system in breast cancer patients. We highlight the mechanisms potentially involved in cancer and antineoplastic therapy-related autonomic imbalance and review the potential strategies to prevent and/or attenuate autonomic dysfunction.

There are gaps in the current knowledge; more research in this area is needed to identify the relevance of autonomic dysfunction and define beneficial interventions to prevent cardiovascular disease in breast cancer patients.

Keywords: Autonomic dysfunction, Breast cancer, Antineoplastic therapies, Autonomic neuropathy, Cardiotoxicity, Patients.