Does cancer radiation treatment affect the heart? Let's talk about Radiation Heart Disease!

If you have had radiation therapy for cancer, or if someone you know has, you may have heard that these treatments can have some effect on the heart. This is actually a bit of a concern. But don't worry, because the most important thing is to be aware of it. So today we'll talk about what this so-called radiation heart disease is, how it develops, who is at higher risk for it, and what else can be done about it.

What is Radiation Heart Disease?

Simply put, radiation heart disease is a collection of different disorders and problems that can occur in the heart as a result of radiation therapy, which is used to kill cancer cells. Think about it, when radiation beams are directed at the site of the cancer, there is a possibility that some damage may occur to the healthy tissues nearby, especially the heart. This damage can sometimes appear within a few weeks of receiving radiation therapy, or it can appear even years later.

This condition often occurs in people who have had radiation treatment to the chest area for the following types of cancer:

• Breast cancer
• Esophageal cancer
• Hodgkin lymphoma
• Lung cancer

How does radiation treatment affect the heart?

Radiation can damage the tissues in and around your heart. In the short term, this can cause inflammation of the heart. This means that parts of the heart become swollen, red, and painful. Over time, this damaged tissue can gradually thicken and become fibrous. It's like a scar forming on a wound. Then the tissue can no longer function properly.

The parts of the heart that are most likely to be affected by radiation therapy are:

• Coronary arteries: These are the arteries that supply blood to the heart muscle . If these are damaged, blood flow to the heart can be reduced.
• Cells that produce and carry electrical impulses to maintain the heart's rate and rhythm (conduction system): This is like the electrical wiring of the heart. If this is damaged, the heartbeat can become irregular.
• Myocardium: This is the main pumping part of the heart. If it weakens, the heart will not be able to pump blood properly.
• HeartThe pericardium: This is like a protective sac around the heart. It can become inflamed.
• Valves between the chambers of the heart: These help blood flow in only one direction. If these are damaged, blood can start to flow backwards.

Short-term effects

The main short-term effects of radiation therapy on the heart are on the pericardium. These conditions include:

• Pericarditis : This is inflammation of the membrane surrounding the heart.
• Pericardial effusion: This is the accumulation of watery fluid between the heart and the pericardial sac.

These conditions usually occur within a few weeks to a few months of receiving radiation therapy. They are most common in people who have been treated for a cancer called Hodgkin lymphoma .

Long-term complications

Some heart conditions can take years, sometimes as long as 20 years, to develop. Long-term complications include:

• Congestive heart failure : The heart is unable to pump enough blood to the body.
• Coronary artery disease: Narrowing or blockage of the arteries that supply blood to the heart.
• Cardiomyopathy: The heart muscle becomes weak, thickened, or enlarged.
• Heartbeat irregularities (Arrhythmia): An irregular heartbeat, either too fast or too slow.
• Constrictive pericarditis: The membrane surrounding the heart becomes thick and stiff, preventing the heart from expanding properly.
• Valvular heart disease: Heart valves not working properly.

Who is most at risk?

If you have had radiation treatment to your chest, especially the left side where your heart is, you may be at risk for this heart disease. The unit of measurement for radiation is called a Gray (Gy) . Generally, the risk of radiation heart disease increases if the total dose exceeds 30 Gray (Gy) over several radiation treatments.

In addition, there are other factors that increase this risk:

• Concomitant treatment with other cardiotoxic chemotherapy medications , such as trastuzumab or anthracyclines.
• Having a pre-existing heart condition.
• Getting younger while undergoing radiation treatment.

Additionally, certain health conditions and lifestyle habits can also increase this risk:

• Obesity.
• Diabetes (Diabetes Mellitus).
• Excessive alcohol use.
• High blood pressure.
• Lack of physical exercise.
• Smoking.
• Unhealthy cholesterol levels.

How common is this condition?

In the past, there was a lack of understanding of the risk of cardiotoxicity, so there were more cases of heart damage from radiation therapy. But now, doctors and specialists have done a lot of research on this and have developed new, safer techniques. This has made it possible to minimize the amount of radiation reaching the heart. So, fortunately, the number of people who develop this radiation heart disease has now decreased.

What are the symptoms of radiation heart disease?

The symptoms of radiation heart disease can vary from person to person, depending on how quickly symptoms appear and the type of heart disease caused by radiation.

Short-term radiation heart disease symptoms

The main symptom of both pericarditis and pericardial effusion, which are short-term side effects of radiation therapy, is severe chest pain . This pain:

• It decreases when you sit and lean forward.
• It increases when you breathe loudly.

Also, difficulty breathing (dyspnea) may occur. This is relieved by bending forward.

Symptoms of long-term radiation heart disease

Radiation heart disease may not cause any symptoms until it is very advanced. The symptoms you have will depend on the type of heart disease you have. Common symptoms of heart disease include:

• Chest pain or discomfort.
• Dizziness or fainting (syncope).
• Dry cough.
• Nausea.
• Fast or irregular heartbeat (palpitations).
• Difficulty breathing.
• Swelling (edema) of the ankles, legs, feet, or abdomen.
• Weakness or extreme fatigue.

Important: Severe radiation heart disease can lead to a fatal heart attack or cardiac arrest.

A heart attack or cardiac arrest is a life-threatening emergency. If you suspect that you or someone you are with is having a heart attack, go to the nearest hospital emergency room or call your local emergency services immediately. Time is of the essence. Even a few minutes of delay can cause permanent damage or even death.

How do you recognize this?

Doctors use a variety of tests to diagnose radiation heart disease. The tests you use will depend on your symptoms and medical history. In addition to a physical exam and blood tests, your doctor may order one or more of these tests:

• Cardiac catheterization
• Cardiac CT scan
• Cardiac MRI
• Chest X-ray
• Echocardiogram
• Electrocardiogram (EKG or ECG)
• Electrophysiology test
• Exercise stress test
• Holter monitor
• Endomyocardial (heart) biopsy

What are the treatments?

There are many treatments for heart disease. These range from lifestyle changes to medications, minimally invasive treatments, and surgery. Your doctor will discuss with you which treatment is best for you.

With new advances in heart disease treatment, people are now able to live longer and better lives.

How can new technology reduce this risk?

The main way to prevent radiation heart disease is to limit the amount of radiation your heart receives.

The latest advanced radiation technologies for cancer deliver precise doses of radiation to the tumor, reducing the amount of radiation that reaches surrounding healthy tissue, especially the heart. Some of these include:

• Intensity-modulated radiation therapy (IMRT): This involves performing three-dimensional (3D) tumor mapping and delivering radiation beams in a very controlled manner.
• Proton therapy: This uses high-energy, positively charged particles (protons) and focuses the energy almost entirely on the tumor.

Also, when treating breast cancer, you can reduce the amount of radiation you receive to your heart by changing your position. For example, you can have treatment while you are lying on your stomach, or you can only receive radiation during short periods of time when you take deep breaths.

How can you reduce this risk?

If you have had radiation treatment to the chest, you can reduce your risk of developing heart disease by adopting a heart-healthy lifestyle. That means:

• Avoiding alcohol consumption.
• Eating a healthy diet.
• Exercising regularly.
• Controlling blood pressure and cholesterol levels.
• Quitting smoking completely.

After cancer treatment is complete, it is also important to have regular follow-up care. This can help monitor your overall health. Your doctor may also order tests to check your heart function every 5 to 10 years.

What can those who have undergone radiation treatment think about the future?

As more people are surviving cancer and living longer, our understanding of the long-term effects of treatment is expanding. The longer you live after cancer treatment, the greater your risk of developing heart disease. However, this risk is now decreasing thanks to new technologies that reduce radiation exposure to the heart.

Your individual outlook depends on these factors:

• The amount of radiation your heart received.
• Your age when you received radiation treatment.
• Your cardiovascular risk factors. That means your diet, exercise, and other health conditions you have.

When should you see a doctor?

If you experience any symptoms of heart disease, call your doctor immediately. These symptoms include chest pain or discomfort, shortness of breath, or an irregular heartbeat.

If you suspect you are having a heart attack or cardiac arrest, seek emergency treatment immediately.

People who have had radiation therapy for cancer in the chest area can develop radiation-induced heart disease years later. However, recent advances in radiation technology have reduced the number of people who develop heart disease from radiation. Treatments for heart disease have also improved, allowing for a better quality of life. If you have had radiation therapy in the past and you have any symptoms of heart disease, be sure to tell your doctor.

Summary (Take-Home Message)

Well, we've talked a lot about Radiation Heart Disease today. Here are some of the most important things to remember:

• Radiation therapy to the chest for cancer can damage the heart.
• This effect can occur in the short term or in the long term (after years).
• This risk has now been greatly reduced due to new radiation technologies.
• If you have had radiation treatment, it is very important to follow a heart-healthy lifestyle and have regular medical checkups.
• If you experience symptoms such as chest pain and difficulty breathing , do not panic and seek medical advice without delay.

There is nothing to fear, awareness and care are the most important things. If you have any further questions about this, talk to your doctor.

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