Heart Problems

Approved by the Lineagotica Editorial Board, 12/2016

Heart problems are an uncommon but serious side effect of some cancer treatments. They may also be referred to as cardiac toxicity. Heart problems can affect treatment, lower a patient’s quality of life, and, rarely, cause death.

Not all treatments for cancer are linked with heart problems. And, there are ways to prevent heart problems or manage them if they do occur.

Relieving this and other side effects is an important part of cancer care. This approach is called palliative care or supportive care. Talk with your health care team about any new symptoms or changes in symptoms that you experience.

Symptoms of heart problems

People experiencing heart problems may have the symptoms listed below. If you notice any of these symptoms, it is important to contact your health care team right away.

  • Shortness of breath

  • Lightheadedness or dizziness

  • Discomfort or pain in the chest

  • Fatigue

  • Swollen hands and/or feet

Types of heart problems

Below is a list of heart conditions that could develop after cancer treatment:

  • Cardiomyopathy and congestive heart failure (CHF), damage to the heart which makes it unable to pump blood well

  • Myocarditis, swelling of the heart that can affect the heart beat

  • Coronary artery disease, a blockage or scarring of the blood vessels of the heart

  • Arrhythmia, an irregular heartbeat

  • Damage to heart valves, causing the valves to narrow and stiffen or leak

  • Problems with the outer membrane of the heart called the pericardium, such as swelling (pericarditis) or thickening or scarring (pericardial fibrosis)

Causes of heart problems

Not all treatments or drugs for cancer are linked with an increased risk of heart problems. The following cancer treatments are more likely to cause heart problems:

  • Chemotherapy with drugs called anthracyclines, which include:

    • Daunorubicin (Cerubidine)

    • Doxorubicin (Adriamycin, Doxil)

    • Epirubicin (Ellence)

    • Idarubicin (Idamycin)

    • Valrubicin (Valstar)

  • Chemotherapy with certain other drugs, such as mitoxantrone (Novantrone)

  • Radiation therapy to the chest

  • Some types of targeted therapy, including:

    • Bevacizumab (Avastin)

    • Trastuzumab (Herceptin)

    • Lapatinib (Tykerb)

    • Sunitinib (Sutent)

    • Sorafenib (Nexavar)

Who is at risk for heart problems from cancer treatment?

People who may have a higher risk of heart problems include:

  • People 60 and older, young children, and women

  • Those who received high doses of anthracyclines

  • People who had high-dose radiation therapy to the chest

  • People who had a combination of anthracyclines and radiation therapy to the chest

  • Those who received anthracyclines or trastuzumab and have a history of smoking, high blood pressure, diabetes, obesity, and/or heart problems before cancer treatment

  • Those who received anthracyclines followed by trastuzumab

Before recommending cancer treatments that may increase the risk of heart problems, your doctor will do a physical exam and other tests. In addition, you and your doctor should talk about your health history to learn about any other possible risk factors for heart problems.

Diagnosing heart problems

If you experience heart-related symptoms during or after treatment, your doctor may perform tests to find the cause. Depending on the results of testing or the tests needed, your doctor may refer you to a cardiologist. A cardiologist is a doctor who specializes in diagnosing and treating heart conditions.

  • Physical exam. Your doctor may listen to your heart beat or the sound of the blood moving through the major vessels in the neck. During this test, the doctor is looking for any usual sounds or changes to your heart beat. These may be a sign that further tests are needed.

  • Echocardiogram (echo). An ECHO is a noninvasive test that looks at the structure and function of the heart using sound waves and an electronic sensor.

  • Multigated acquisition (MUGA) scan. A MUGA scan creates video images of the lower chambers of the heart that hold blood (called “ventricles”) to check whether they are pumping blood properly.

  • Cardiac Magnetic Resonance Imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A cardiac MRI takes images of the heart. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye is usually injected into a patient’s vein.

  • Blood tests. There are certain signs of heart damage that may show up in the blood. Your health care team can test for these.

  • Angiogram. This procedure takes a picture of the blood vessels using a dye that is injected into the artery. Then, the artery is examined with a special x-ray device called a fluoroscope.

  • Chest x-ray. A chest x-ray is a picture of the inside of the chest.

  • Electrocardiogram (EKG, ECG). An EKG is a noninvasive test that looks for abnormal heart rhythms or heart damage.

Watching for heart problems

Your doctor may recommend monitoring for heart problems even if you don’t have symptoms. This is especially important for those who have a higher risk or who are receiving ongoing treatment with trastuzumab for metastatic breast cancer. The American Society of Clinical Oncology (ASCO) provides recommendations for monitoring for heart problems. The main test recommended is an echocardiogram, but cardiac MRI or a MUGA scan may also be used. Testing may be done periodically during treatment and/or 6 to 12 months after cancer treatment ends.

Preventing and managing heart problems

Your health care team may recommend options to help you avoid the risk of heart problems from cancer treatment. Below is a list of possible options:

  • Giving a different drug. Not all drugs cause heart problems. There may be equally effective drugs available that are not linked to heart problems.

  • Giving less of the drug or in a different way. You may be able to receive a lower dose that is still effective to treat the cancer but less likely to affect the heart. Your doctor may also recommend giving the drug in ways that can lessen heart damage.

  • Giving additional drugs that could help protect your heart from damage. The drug dexarazoxane (Zinecard) can help prevent heart problems from anthracyclines. There are also other drugs being researched to help prevent heart damage.

  • Reducing radiation therapy to the heart. This may include using a lower dose. Or, there are some techniques that can help avoid it damaging the heart. These include deep inspiration breath holding and intensity modulated radiation therapy (IMRT). Deep breath holding may be used for some cancers when the heart might be unnecessarily exposed to treatment. It involves taking a deep breath and holding it for short periods while the radiation is being given. IMRT is a type of radiation therapy that directs the radiation dose at the tumor by varying the intensity of the beam.

If you do develop a heart problem after cancer treatment, your doctor may recommend some medications to manage it. These could include 1 or more of the following:

  • Diuretics, which are medications that eliminate excess fluid from the body by increasing urination

  • Blood pressure medications, such as ACE inhibitors or beta-blockers

  • Digitalis, which helps regulate the heart beat

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