Managing heart problems

If you develop any heart problems, your doctors will discuss with you the best way to manage them. Treatment may include:

  • Heart drugs – Drugs are commonly used to treat heart problems. There are different types of heart medicines that work in different ways to treat heart problems. These include ACE inhibitors, angiotensin receptor antagonists (ARBs), beta blockers, aldosterone antagonists, cholesterol-lowering medicines, diuretics (water tablets) and anti-platelet medicines. You can find more information about heart drugs, how they work and possible side effects below. Ask your cancer doctor or GP if you have any questions about your drugs.

  • Temporarily stopping treatment – With some treatments, such as trastuzumab, you might need to stop your treatment temporarily. This is so your heart function can return to normal. In some cases, you may need to change your treatment.

  • Surgery – Some heart problems, such as coronary heart disease, might need to be treated with a procedure or surgery. Any heart procedures will be carried out by a specialist doctor.

Deciding how to manage heart problems

Your doctors will decide the best way to manage any heart problems that develop during or after your cancer treatment.

Treatment may include:

  • Taking heart drugs.
  • Altering your cancer treatment. For example, temporarily stopping it, lowering the dose, switching to a different treatment with less risk to the heart, or occasionally stopping the treatment completely.
  • Having a procedure or surgery.


Heart drugs

Drugs are commonly used to treat a number of different heart problems. This section lists some of the drugs that you may be prescribed if you have problems with your heart. It also explains how each drug works and what the side effects are.


Names of heart drugs

We’ve used drug names above rather than the names the drug company gives them (the trademark names). You might sometimes hear the drugs above called by their trademark name. Ask your cancer doctor or GP if you’re unsure about anything related to your heart drugs.

You may be prescribed, or already be taking, a heart medicine that is not included in this table. Your doctor or pharmacist will be able to give you more information about your heart drugs. You can also get more detailed information from the British Heart Foundation.

Heart drugs may interact with some cancer treatments. Always tell your cancer doctor about any medications you are taking so that they can make sure there is no interaction.


ACE inhibitors

Examples

Captopril, Cilazapril, Enalapril, Lisinopril, Perindopril, Ramipril, Trandolapril.

How it works

ACE inhibitors work by making your blood vessels relax and widen, which helps improve the flow of blood to your heart muscle. They also help protect the heart muscle.

They are used to treat heart failure, high blood pressure and heart valve disease. They are also sometimes used after a heart attack.

These drugs may be used to protect your heart from chemotherapy drugs.

Possible side effects

  • Low blood pressure.
  • Changes in kidney function.
  • A cough.


Angiotensin receptor antagonists (ARBs)

Examples

Candersartan, Irbesartan, Losartan, Valsartan.

How it works

These drugs relax your blood vessels.

They are used to treat high blood pressure.

They may also protect your heart from chemotherapy drugs.

Possible side effects

  • Low blood pressure.
  • Dizziness.
  • Diarrhoea.


Beta blockers

Examples

Atenolol, Bisoprolol, Carvedilol, Metoprolol, Nebivolol, Propranolol, Sotolol.

How it works

They work by slowing your heart rate, which reduces the amount of work the heart has to do. This takes the strain off the heart muscle.

They control high blood pressure, treat abnormal heart rhythms, and reduce the risk of angina and heart attacks. They can also be used to treat heart failure.

These drugs may protect your heart from chemotherapy drugs.

Possible side effects

  • Tiredness.
  • Cold hands and feet.
  • Disturbed sleep.
  • Vivid dreams.
  • Mood swings – can make a low mood worse.
  • Erectile dysfunction.
  • Diarrhoea.


Aldosterone antagonists

Examples

Eplerenone, Spironolactone.

How it works

They work by blocking the actions of a hormone (aldosterone) released by the kidney, which can damage the heart muscle.

They are used to treat heart failure.

These drugs may protect your heart from chemotherapy drugs.

Possible side effects

  • Low blood pressure (causing dizziness).
  • Changes to kidney function.
  • Increased levels of potassium in the blood. If your potassium level is too high, the drug may need to be stopped.
  • Spironolactone may cause discomfort in the breast tissue.


Cholesterol-lowering medicines

Examples

Atorvastatin, Bezafibrate, Ciprofibrate, Ezetimibe, Fluvastatin, Pravastatin, Rosuvastatin, Simvastatin.

How it works

These drugs reduce the amount of cholesterol in the blood and reduce the risk of coronary heart disease and heart attacks.

Possible side effects

  • Tiredness.
  • Feeling and being sick.
  • Diarrhoea.
  • Constipation.
  • Headache.
  • Muscle weakness.


Diuretics (water tablets)

Examples

Amiloride, Bendroflumethiazide (Bendrofluazide), Bumetanide, Chlortalidone (Chlorthalidone), Furosemide (Frusemide), Metolazone, Torasemide.

How it works

These drugs act on the kidneys. They remove excess water from the body, which is caused by your heart not pumping as well as it should.

They are used to treat the symptoms of heart failure, heart valve disease and high blood pressure.

There are different types of diuretics. Each one works in a slightly different way. Your doctor will be able to tell you more about the type of diuretic you are taking.

Possible side effects

  • Needing to go to the toilet more during the day and possibly at night.
  • Needing to go to the toilet more urgently.
  • Dizziness or light-headedness.
  • Thirst.
  • Changes in kidney function.


Anti-platelet medicines

Examples

Aspirin, Clopidogrel, Dipyridamole, Prasugrel, Ticlopidine.

How it works

These drugs help to make the blood less ‘sticky’ and reduce the risk of clots forming. This reduces your risk of having a heart attack or stroke.

They may be given to people who have coronary heart disease, angina, heart failure or heart valve disease.

Possible side effects

  • Bleeding in the stomach or bowel.
  • Indigestion.
  • Stomach aches.
  • Feeling sick and being sick.

These side effects most commonly happen with aspirin. To help prevent these side effects, always take aspirin after a meal and never on an empty stomach.

If you’re having chemotherapy, there’s a risk that the number of your platelets (blood cells that help the blood to clot) will get low. If your platelets are low, your cardiologist and oncologist will discuss the potential risks against the benefits of being treated with these medications.


Temporarily stopping treatment

With some cancer treatments, for example trastuzumab, you may need to stop your treatment for a period of time until your heart function returns to normal. Occasionally, you may need to stop treatment completely. If this happens, your doctors will talk to you about other treatments that are more suitable for you.


Surgery

Some heart problems may need treatment with a procedure or surgery. For example, coronary heart disease can be helped by a procedure that involves putting a small tube (a stent) into a narrowed artery. The stent keeps the narrowed artery open so that oxygen-rich blood can flow more easily to supply the heart muscle.

Heart procedures or surgery are always carried out by a doctor who specialises in them. These doctors are known as cardiothoracic surgeons or cardiologists. You will meet with the surgeon before any surgery is done so you have time to ask any questions.


Working together to create information for you

We worked with British Heart Foundation to write our content on heart health.

Thank you to all of the people affected by cancer who reviewed what you're reading and have helped our information to develop.

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Back to Cancer treatment and your heart

Chemotherapy

A few chemotherapy drugs affect the heart. Your hospital team will talk to you about any risks of the drugs you’re having.

Radiotherapy

Radiotherapy only affects the heart if it’s in the area treated. Improvements in radiotherapy treatment have reduced the risk of problems.

Hormonal therapies

Treatment with hormonal therapies can sometimes increase the risk of heart problems.

Surgery for cancer

You’ll usually have tests to check your heart before you have an operation to treat a cancer.

Cancer research trials

If you take part in a clinical trial, you will have regular checks for any side effects.