Can cancer treatments affect your heart? Let's talk about cardiotoxicity!

Are you undergoing cancer treatment? Or is someone you know undergoing such treatment? Sometimes cancer treatments can have a small impact on our heart. That's what we're going to talk about today. We call this cardiotoxicity . Don't worry, let's understand this simply.

So what is cardiotoxicity?

Simply put, cardiotoxicity is the damage to our heart caused by certain cancer treatments or cancer medications. Keep in mind, sometimes this effect can occur even years after cancer treatment. This risk is especially high for adults who were treated for cancer at a young age, that is, as children. Not all cancer treatments cause this, but there are some treatments that have a higher risk of causing cardiotoxicity.

This condition can make it harder for your heart to pump blood properly throughout your body. In some severe cases, this can even lead to a heart muscle disease called cardiomyopathy , which makes it even harder for your heart to pump blood.

Who is most likely to be affected by cardiotoxicity?

In fact, anyone who has undergone cancer treatment is at risk of developing cardiotoxicity. However, the risk is higher for those who have used certain medications or have had radiation therapy to the chest area.

Also, as mentioned earlier, this condition is somewhat common among people who have been treated for cancer in their childhood, that is, in adulthood. It is difficult to say exactly how common this is among people who have been treated for cancer in adulthood. However, according to some reports, about 20% of these people may face heart disease, and between 7% and 10% may develop cardiomyopathy or heart failure. So it is very important to be aware of this.

How does this cardiotoxicity affect your body?

Cardiotoxicity can cause various heart problems. Let's take a look at what they are:

• Cardiomyopathy: This is when the heart muscle becomes weak and the heart is unable to pump blood properly.
• Myocardial Infarctions or Heart Attacks: You've probably heard of this one. It can be caused by a blockage in the arteries that supply blood to the heart.
• Coronary Artery Disease: Narrowing or blockage of the arteries that carry blood to the heart.
• Heart Failure: The heart is unable to pump blood to meet the body's needs.
• Heart Valve Disease: Heart valves not working properly.
• Irregular heartbeat (Arrhythmia): An irregular heartbeat, either beating slowly, rapidly, or without rhythm.
• Fluid Buildup Around the Heart.
• Low or High Blood Pressure.
• Slow Heart Rate.
• Constrictive Pericarditis: In this condition, the outer membrane of the heart thickens, reducing the space for the heart to expand freely.

What are the symptoms of cardiotoxicity?

There are several symptoms of heart disease related to cardiotoxicity. If you have one or more of these, it is important to be concerned:

• Abdominal distension: The stomach bulges forward, like a bulge.
• Chest Pain: The chest may feel tight or constricted.
• Dizziness.
• Heart Palpitations: Imagine feeling like your heart is racing inside your chest, or beating loudly.
• Dyspnea or Shortness of Breath: You feel short of breath and gasp even after doing a little activity.
• Swelling of the legs and fluid retention (edema): Swelling occurs, especially in the legs and ankles.

What are the main causes of cardiotoxicity?

There are some cancer treatments that can cause cardiotoxicity. The most important of these are:

• Anthracyclines: For example , Doxorubicin (Adriamycin®) . These are a type of chemotherapy drug commonly used to treat cancers such as leukemia, lymphoma, breast cancer, sarcoma, or multiple myeloma .
• Trastuzumab (Herceptin®): This is a targeted therapy drug used to treat breast cancer, stomach cancer, or cancer of the gastroesophageal junction. There is an increased risk of cardiomyopathy, especially when this drug is given in combination with an anthracycline.
• Radiation Therapy to the Chest: This is also used to treat diseases like breast cancer or leukemia .

How do doctors diagnose this condition of cardiotoxicity?

Doctors mainly look at how well your heart is pumping blood to determine if you have cardiotoxicity. This is measured by a test called the Left Ventricular Ejection Fraction (LVEF) . They also look at how well your heart valves are working. The LVEF measures how much blood is pumped out of the lower chamber on the left side of your heart (the Left Ventricle) at a time.

There are several tests that doctors use to measure these things:

• Echocardiogram: This is the main imaging test often used to detect cardiotoxicity. It uses electrodes and ultrasound waves to check your heart rate and the way blood flows through your heart. It's similar to the scan that's done for expectant mothers, but this one is for the heart.
• Cardiac MRI: Some specialists say this is the gold standard test for detecting cardiotoxicity. It uses magnets, radio waves, and a special computer to take detailed pictures of your heart's structures and assess how blood flows through it.
• Cardiac Stress Test: This test measures how your heart responds to strenuous activity. You are asked to walk on a treadmill or ride a stationary bike. During this time, you are connected to a machine that measures your heart rate and blood pressure.
• Multigated Acquisition Scan (MUGA): This test evaluates the function of your heart chambers (ventricles). A safe radioactive tracer is used for this. It is clearly visible on the scan. The doctor watches how this tracer moves through your blood vessels, and then calculates your ejection fraction.
• Cardiac CT Scan: A CT scan takes X-rays from different angles to create a detailed picture of the heart. This test can be very useful, especially for people who suspect cardiotoxicity after radiation therapy to the chest.

How is this cardiotoxicity condition treated?

Depending on the medications you are currently taking, your doctor may recommend stopping some of them or reducing their dosage. Your doctor may also prescribe medications that help your heart work more efficiently. For example:

• ACE inhibitors: For example , Lisinopril (Zestril®) or Fosinopril Sodium (Monopril®) . These work by opening up your arteries and making it easier for blood to flow.
• Beta-blockers: For example , metoprolol (Lopressor®) or atenolol (Tenormin®) . These increase blood flow and slow down the heart rate.
• Digoxin, also known as Digitalis (Lanoxin®): This slows the heart rate and helps the heart beat more efficiently.
• Diuretics (also called water pills): For example , Furosemide (Lasix®) . These work by removing excess fluid (water) from the body through urine.
• Vasodilators: For example , Isosorbide Dinitrate (Isordil®) . These work by widening (opening) blood vessels, allowing blood to flow more easily.

Is there anything we can do to reduce the risk of cardiotoxicity?

In fact, there is no way to completely prevent cardiotoxicity. However, if you are diagnosed with cancer, it is very important to discuss the pros and cons of treatment options, that is, the health risks and benefits, with your doctor.

Also, regular heart imaging tests during cancer treatment can help detect cardiotoxicity at an early stage. Just think, if there is a problem, the earlier it is identified, the more likely it is to be successfully treated.

Can this cardiotoxicity be reversed, that is, cured?

Sometimes, yes. There are cases where cardiotoxicity can be reversed. Research has shown that cardiotoxicity after using a drug called Trastuzumab can be reversed.

However, cardiotoxicity caused by the use of anthracyclines is often difficult to reverse. It requires long-term treatment. Similarly, cardiotoxicity associated with chest radiation is also very difficult to reverse. Sometimes long-term treatment, and even surgery, may be required.

When should I seek medical advice immediately? What to do in an emergency?

If you have any symptoms of a serious heart condition, call 911 immediately for an ambulance, or go to the nearest emergency room. Be especially aware of these symptoms:

• Palpitations or a feeling of rapid heartbeat that is persistent.
• Dizziness, feeling light-headed, or passing out.
• Sudden increase in shortness of breath or chest pain.
• Swelling of the throat or lips.
• Unusual swelling of the legs or feet.
• Weight gain of more than 1.5 kg (3 pounds) within a week.

If you have these symptoms , it is important to seek medical advice immediately without wasting time, as these could be signs of a serious condition, such as a heart attack.

Finally, the most important take-home message!

Okay, we've talked a lot about cardiotoxicity. Simply put, cardiotoxicity is damage to the heart caused by cancer treatments. It's especially common in people who have received certain chemotherapy drugs, targeted therapy drugs, or radiation therapy to the chest.

While some types of cardiotoxicity can be reversed, others require long-term treatment. The most important thing is to talk openly with your doctor about the benefits and potential risks of your treatment if you are undergoing cancer treatment. Also, having regular heart tests during your treatment can help identify any problems early and start treatment sooner.

Don't panic, but be aware. Take care of your heart. If you experience any unusual symptoms, don't ignore them. Seek medical advice immediately.

` Cardiotoxicity, Cancer Treatment, Heart Disease, Chemotherapy, Radiation Therapy, Heart Health, Cardiotoxicity