Changes to the way the heart works
Some cancer treatments can affect how the heart works. It’s important to remember that most young people treated for cancer won’t develop heart problems. But some people will, and that’s why we’ve included some information about it here.
Effects on the heart can be temporary or permanent. Some might be minor, while others can be more severe.
If you’ve had treatments that put you at risk of getting heart problems, your doctor will keep a check on this. So even though your treatment’s finished, you might need occasional tests. This means any problems can be picked up and treated early. How long your follow-up goes on for depends on the type of treatment you had. Your doctor can tell you what kind of tests you might need and for how long.
Which treatments might affect the heart?
Certain treatments can increase a person’s risk of developing heart problems in the future.
A group of chemo drugs called anthracyclines can cause heart problems. Doxorubicin and epirubicin are examples of anthracyclines.
Other chemo drugs that can cause heart problems include cyclophosphamide, capecitabine, cytarabine and Mitroxane. We have more info about these drugs.
Having radiotherapy to the chest or the mid to upper back (thoracic spine) can sometimes cause heart problems. Total body irradiatation (TBI) can also cause heart problems.
Targeted therapies are drugs that work by changing the way cells interact with each other.
Monoclonal antibodies are a type of targeted therapy that can affect the heart. Examples of monoclonal antibodies used to treat young people are rituximab and trastuzumab (also known as Herceptin®).
Possible heart problems
Remember that a lot of these problems are rare and can vary from mild to severe. These are some of the heart problems that can happen after cancer treatment:
- If the cells in the muscle around the heart are damaged by cancer treatment, it might mean the heart can’t relax and contract normally. If this happens, it can cause something called cardiomyopathy or left ventricular dysfunction.
- The protective covering around the heart might become inflamed. This is called pericarditis. The heart’s protective covering can also get scarred, which is called pericardial fibrosis.
- The valves in the heart can become stiff or leaky, which is called valvular stenosis or insufficiency. This happens if cancer treatment affects the valves and blood vessels in the heart.
- If the electrical pathways that control the heart rate get damaged, it can cause heart arrhythmias (abnormal heart rhythms). This can cause a fast, slow or irregular heart rate.
- If the heart’s blood vessels become scarred or blocked, it might be hard for oxygen and other nutrients to get to the heart and other organs. This is called coronary heart disease.
Symptoms of heart problems
It’s important to know which cancer treatment(s) you’ve had, because some heart problems can happen years later. Your treatment(s) will be listed in your medical records, but it’s helpful if you keep a note of them too.
The symptoms of a heart problem can vary from mild to severe, and can affect people in different ways. Symptoms can include:
- shortness of breath
- dizziness, light-headedness or fainting
- chest pain that might spread to your arm
- nausea or vomiting
- very swollen feet and ankles
- feeling like your heart’s racing or skipping a beat
- coughing or wheezing that doesn’t go away
- a sharp pain on the left side of your chest that’s often worse when taking a deep breath in.
Sometimes a person doesn't have any symptoms, but a problem is found when they have the tests their doctor ordered.
If you have any of these symptoms, or if you have other symptoms that are worrying you, tell your healthcare team. They can arrange any tests and treat you if necessary.
Having tests for heart problems
Your doctor will tell you exactly what follow-up they want you to have. Commonly used heart tests include:
• an electrocardiogram (ECG)
• an echocardiogram (an ultrasound scan of your heart)
• a MUGA scan.
How often you need these tests depends on what the heart problem is and how severe it is. It’ll also depend on what else is happening in your life. For example, if you’re a girl and you're pregnant or planning to have a baby, the doctor might decide to do them more often, because of the extra strain pregnancy can cause.
If you have any questions about why your healthcare team want to do tests, it’s fine to ask.
Looking after your heart
It can be worrying to read about things going wrong with your heart. But remember that heart problems after cancer treatment are rare. The good news is that you can help reduce the chance of these problems developing.
If you’re a smoker, it’s a great idea to quit. There’s lots of help and support around for you. You can ask your GP for advice or have a look at the NHS stop smoking website.
Having a healthy diet and doing regular exercise also helps keep your heart healthy.
Heart problems can be a long-term effect of cancer treatment, but probably won’t affect most people. But it’s important that you have the right follow-up if you’re at risk of developing them. If you have any questions or concerns, remember to ask your doctor or nurse.