Anthracyclines are commonly used antineoplastic drugs. However, their clinical utility is tempered by a dose-dependent risk of cardiotoxicity and congestive heart failure. Current preventive measures focus on dose reduction, use of less cardiotoxic anthracycline analogues and prophylactic use of dexrazoxane. Recent research has focused on early monitoring and risk stratification to identify patients that are ‘at risk’ for cardiotoxicity, using biochemical markers and the prophylactic use of novel cardioprotectants. This article reviews the clinical course, pathogenesis, cardiac monitoring and new concepts in diagnosing and preventing anthracycline cardiotoxicity.