Radiotherapy is one of the main treatments for esophageal cancer (EC), but it inevitably leads to heart damage, some of which may occur after years or even decades. Although the survival period of EC patients has been gradually increased with the advancement of diagnosis and treatment technologies, radiation-induced heart disease (RIHD) caused by local advanced esophageal cancer radiotherapy has become the leading cause of non-tumor death. In order to minimize the damage caused by radiation to the heart, reduce the incidence of radioactive RIHD and improve the survival rate of the patients, this article reviews the anatomical relationship between heart and esophagus, the mechanism and manifestations of RIHD, and the effects of different radiotherapeutic techniques on cardiac tissue, and explores existing screening and treatment strategies for RIHD.