26 Sunitinib and sorafenib impair the angiogenic response necessary to overcome the effects of HTN-induced pressure overload to the heart, thus resulting in an increased incidence of cardiac dysfunction and HF.2 Sunitinib is also reported to inhibit platelet-derived growth factor receptors (PDGFR) resulting in decreased myocardial pericytes and microvascular density.38 Similar findings were reported in pazopanib-treated patients with some unique case reports of the apical ballooning syndrome and rapidly progressive fulminant HF.39 This evidence concerns the gene PDGFRB and hydrops fetalis.