Before the 60s the heart was thought to be resistant to the effects of radiotherapy.Later reports started to describe radiation induced heart diseases:pericardial,coronary,myocardial,valvular and rhythm disease.I have selected from literature 117 articles-metanalyses,case reports,randomized trials,prospective studies, founding that cardio-toxic effects may occur either as subclinical abnormalities or as severe clinical events;relative risk of fatal cardiovascular (CV) events is life long, and absolute risk appears to increase with length of time since exposure.Radiation-associated CV toxicity may be progressive.The risk of developing cardiotoxicity depends on several factors: age, time since exposure, older techniques, larger doses, closeness of tumor and heart, combined cardiotoxic agents.Although the new techniques seem to have decreased the incidence of cardiotoxic effects, the risk has not been fully eliminated.A growing body of evidence supports as first choice the surgical approach for radiation heart disease, despite surgery is still associated with a higher risk of mortality.In the absence of clear guidelines, it seems reasonable annual follow up of all high risk patients.