Cancer Treatment and Your Heart Health

Going through cancer treatment can be overwhelming emotionally and physically. Unfortunately, you may have side effects. Some may be obvious, like severe tiredness (fatigue) and vomiting. Others may not be as apparent.

Heart damage (cardiotoxicity) is a possible side effect of certain cancer treatments. Cancer treatment may cause heart and cardiovascular problems including:

• Cardiomyopathy

• Coronary artery disease

• Congestive heart failure

• Heart valve problems

• Fluid buildup around the heart

• High blood pressure

• Irregular heartbeat (arrhythmia)

• Inflammation of the heart (myocarditis)

Heart problems can start during treatment. Or they may develop years after treatment is over.

Which cancer treatments can cause heart problems?

Certain treatments are more likely to cause heart issues.

• Chemotherapy (chemo). Anthracycline chemo medicines may cause heart problems. This includes medicines like daunorubicin, doxorubicin, epirubicin, idarubicin, and valrubicin. Other chemo medicines can also cause cardiovascular problems. They include cisplatin, carboplatin, paclitaxel, and cyclophosphamide.

• Targeted therapy. Some of these medicines can cause heart problems or high blood pressure. These include bevacizumab, dasatinib, sorafenib, sunitinib, lapatinib, pazopanib, and axitinib.

• Radiation therapy. Radiation aimed at the chest may put you at higher risk for heart problems. You are at increased risk if you receive higher doses of radiation. Or if you get radiation and chemo at the same time.

• Immunotherapy. These medicines may cause heart palpitations, low or high blood pressure, or myocarditis.

Who is most at risk?

Some people are at risk for heart problems due to cancer treatment. This includes people who:

• Have the treatments listed above

• Have combination chemo and radiation treatments

• Are age 60 or older

• Are young children

• Are assigned female at birth

• Smoke

• Have diabetes or high blood pressure

• Have excess weight

• Have pre-existing heart problems

• Have a family history of heart problems

• Were treated for cancer as a child

What are the symptoms of heart damage?

Symptoms of heart damage to watch out for include:

• Shortness of breath

• Dizziness

• Fatigue

• Swollen hands or feet

• Heart palpitations or feeling like your heart is racing

When to call the healthcare provider

Call your healthcare provider if you have any of the symptoms of heart damage listed above.

Call 911

Call 911 right away if you have:

• Chest pain or pressure

• Trouble breathing

Preventing heart damage

Your healthcare provider may advise the following options to protect your heart during cancer treatment.

• Lowering the dose of the medicine or radiation you receive.

• Using a different medicine that doesn’t put you at risk for heart damage.

• Taking medicine that helps protect your heart, such as dexarazoxane.

You can help reduce the risk of heart problems by:

• Not smoking. Ask your healthcare provider for help quitting if needed.

• Managing conditions such as high blood pressure, diabetes, or excess weight as well as possible. Ask your healthcare provider how to best manage your health.

How are heart problems diagnosed?

Your provider may check your heart function before, during, and after treatment. This helps your healthcare team know if your heart function has changed. You may have tests such as:

• Echocardiogram (echo). This uses sound waves to look at the heart’s structure and how well blood moves through the heart.

• Blood tests. These can find certain signs of heart damage.

• Electrocardiogram (ECG). This checks the electrical activity of the heart.

• Chest x-ray. This creates an image of the chest.

• Cardiac MRI. This makes an image of the heart.

• Multigated acquisition (MUGA) scan. This checks if the heart's chambers are pumping blood effectively.

How are heart problems treated?

If you’re diagnosed with a heart condition caused by cancer treatment, there are several treatment options available to you.

Your provider may adjust your treatment or dose. They may advise medicines to help control your blood pressure, regulate your heart rhythm, or remove extra fluid from your body. They may also refer you to a heart specialist (cardiologist). In rare cases, other procedures or surgery may be needed.

Being aware of heart damage can help you take the best care of yourself during treatment. Talk with your provider about your risks for heart damage. Working together with your healthcare team can help you stay on top of possible side effects of cancer treatment.