Cardiovascular (CV) toxicity is a short- or long-term complication caused by a variety of anticancer therapies. Some agents, such as anthracyclines or other biologics, may cause irreversible clinical cardiac insufficiency. This article summarizes the new ESMO clinical practice guideline, which integrates evidence from multidisciplinary cardiac oncology reviews and aims to provide standard recommendations for the prevention, assessment, monitoring and management of cardiovascular toxic events arising during cancer therapy. Monitoring of cardiac function Elderly patients: data are lacking and vigilance is recommended for patients aged 60 years and older; patients with metastatic disease: LVEF (left ventricular ejection fraction) should be monitored frequently before initial treatment and during the asymptomatic period thereafter. Patients receiving anthracyclines and/or trastuzumab adjuvant therapy: a series of cardiac function monitoring prior to initial treatment, at months 3, 6, 9, 12, and 18 of treatment. For patients who started anthracycline therapy before age 15, or who started therapy after age 15 but with cumulative doses of adriamycin >240 mg/m2 or epirubicin >360 mg/m2, cardiac function assessments are recommended at 4 and 10 years post-treatment, respectively. Troponin I or BNP concentrations can be used to monitor cardiovascular risk in patients, particularly for class I drugs (e.g., anthracyclines). Periodic monitoring of biomarker concentrations during therapy (each treatment cycle) from before initial treatment may be used to identify patients who require further cardiac evaluation. Treatment with LVEF downregulation of more than 15% from baseline and normal function (LFEV ≥ 50%) means that anthracycline and/or trastuzumab therapy can be continued. Treatment with anthracycline-containing regimens: LVEF decline to <50% means evaluation after 3 weeks. If cardiac dysfunction is confirmed, LVD (left ventricular insufficiency) therapy is considered in conjunction with chemotherapy and frequent subsequent clinical and echocardiographic examinations. If LVEF decreases to <40% discontinue chemotherapy and discuss a change in regimen and treatment of LVD. Trastuzumab after anthracycline therapy: reevaluate after 3 weeks if LVEF decreases to <50% during this period. If confirmed, continue trastuzumab therapy and consider treatment of LVD with further frequent clinical and echocardiographic examinations. Discontinue trastuzumab therapy and treat LVD if LVEF decreases to < 40%. Patients treated with anthracyclines must be treated aggressively even if asymptomatic if LVD (left ventricular insufficiency) is grade D on echocardiography, especially if the patient is expected to survive for a long time. Aggressive therapy includes ACE inhibitors and β-blockers and early HF therapy (within 2 months of anthracycline treatment). For type I drug-induced subclinical cardiotoxicity, which can be identified by elevated cardiac troponin, treatment with an ACE inhibitor (enalapril) may prevent reduced LVEF and associated cardiac events. Patients who develop cardiac insufficiency during or after type II drug (trastuzumab) therapy (without anthracyclines) may be placed under clinical observation if they are asymptomatic and have an LVEF level ≥ 40%. the balance of benefits and risks of antineoplastic therapy must be discussed after a persistent low or further decline in LVEF or the development of symptoms. Patients with LVD (left ventricular insufficiency) should be treated with the same standard guideline-based HF therapy as other patients with HF (heart failure). 1. Symptomatic LVD must be treated with HF. Unless specific contraindications exist, all patients with HF and LVEF <40% must be treated with ACE-I (ACE inhibitor) in combination with BB (β-blocker). For patients with LVEF levels between 40% and 50%, ACE-I should be considered to prevent further reduction in LVEF or the development of clinical HF. 2. Asymptomatic LVD All patients with asymptomatic LVD and patients with ejection fraction <40% should be treated with ACE-Is (ACE inhibitors), and ACE-Is should also be considered if LVEF <50%.