Background <p> Cardiotoxicity has emerged as a major clinical concern associated with targeted cancer therapies. While these agents, including tyrosine kinase inhibitors (TKIs), HER2 inhibitors, angiogenesis inhibitors, and immune checkpoint inhibitors, revolutionize cancer treatment by selectively modulating tumor-associated molecular pathways, they inadvertently disrupt cardiovascular homeostasis due to the overlap of signaling mechanisms between tumorigenesis and cardiac physiology.</p> Objectives <p> This review aims to elucidate the mechanisms underlying cardiotoxicity induced by targeted cancer therapies, outline diagnostic and preventive strategies, and highlight emerging approaches in cardio-oncology for optimizing patient outcomes.</p> Methods <p> An integrative review of preclinical and clinical studies was conducted to analyze the cardiovascular effects of major targeted therapeutic classes. Mechanistic insights, diagnostic modalities, monitoring protocols, and ongoing clinical trials were critically examined to establish a translational perspective.</p> Results <p> Targeted therapies induce cardiotoxicity through multiple pathways, including mitochondrial dysfunction, oxidative stress, endothelial injury, and immune-mediated inflammation. Clinically, these effects manifest as hypertension, arrhythmias, heart failure, and myocardial ischemia. Diagnostic evaluation relies on echocardiography, cardiac biomarkers (e.g., troponin, BNP), and electrocardiography. Preventive and management strategies encompass baseline cardiovascular assessment, dose adjustment, use of cardioprotective agents, and continuous cardiac monitoring. Advances in cardio-oncology have promoted multidisciplinary management and integration of cardiovascular surveillance into cancer care protocols.</p> Conclusion <p> The growing prevalence of cardiotoxicity among cancer survivors underscores the need for collaborative, multidisciplinary care involving oncologists, cardiologists, and researchers. Individualized therapy guided by predictive biomarkers and novel imaging tools holds promise for balancing therapeutic efficacy with cardiovascular safety, thereby improving long-term survivorship and quality of life.</p> Graphical Abstract <p></p>