Cardiotoxicity is a well-recognised late effect of therapy for childhood and adolescent malignancies and is a serious problem for long-term survivors. Cardiotoxicity may be caused by chemotherapy, radiation therapy or the combined use of both modalities. A survey of paediatric cardiology centres in North America found that more than 12% of all patients with cardiomyopathy had been treated for cancer during childhood or adolescence. 1 In a large cohort of American patients who had survived at least five years from a diagnosis of paediatric cancer, the standardised mortality ratio (SMR) for overall mortality was 10.8 and the SMR for cardiac mortality was 8.2. 2 A study from the Nordic countries produced similar findings (overall SMR, 10.8; cardiac and circulatory system death SMR, 5.8). 3 The SMR for sudden or ill-defined deaths was 3.9; some of these deaths were probably attributable to cardiac causes.