Damage to the heart can result in signs of mild heart failure, like shortness of breath, or show no symptoms at all. In some cases the heart damage is severe enough to cause
- cardiomyopathy, when the heart muscle cannot contract
- congestive heart failure, when the heart can’t pump enough blood to give the body the oxygen and nutrients you need
If you are having heart problems, you may have one or more of these symptoms:
- Shortness of breath
- Swelling in the hands, feet, ankles or legs
- Persistent or dry cough
- Increased or irregular heart rate
Symptoms may appear during treatment or weeks or months after treatment ends. Mild heart damage may not show any symptoms and may only be found through heart tests called echocardiograms.
Heart problems are a side effect of some chemotherapy and targeted therapy medicines used to treat breast cancer. Certain types of medicines are more likely to cause heart problems than others. They include
- chemotherapy, especially anthracyclines such as doxorubicin (Adriamycin) and epirubicin (Ellence). Heart damage is often related to the total amount of chemotherapy you receive in your lifetime. For most chemotherapies there is a maximum amount you can get over the course of your life, and then you have to stop.
- radiation therapy. When the heart is exposed to radiation, it increases the risk for heart complications such as cardiac fibrosis, an abnormal thickening or forming of scar tissue on the heart valves. Radiation treatment to the left breast, which is closest to the heart, also increases your risk for heart disease.
- hormonal therapies, such as
- targeted therapies, including
The risk of heart damage is greater with combinations of chemotherapy medicines. But remember, not everyone who takes these medicines develops heart problems, and symptoms and severity can vary among those who do. Older people have a higher risk of developing heart problems from chemotherapy.
Heart problems can also be caused by lifestyle factors like smoking, being overweight, eating foods high in fat and cholesterol and not exercising enough.
Before you start treatment, talk with your providers about existing or past health problems. Let them know if you have a history of heart disease or receiving chemotherapy, or you had radiation therapy to your chest in the past.
Your doctor will test you for heart problems before you start treatment and monitor your heart closely during treatment, especially if you have a history of risk factors. Researchers are looking at whether beta blockers and ACE inhibitors, common medicines for high blood pressure, may protect the heart if given before cancer treatment.
Tests may include
- an echocardiogram, a common test that allows your doctors to see how your heart is working. This test records electric currents created by your heart.
- a MUGA scan, which creates video images of the lower chambers of the heart and checks the movement of blood through the heart.
- a left ventricular ejection fraction (LVEF) test, a way to measure how well your heart is pumping blood. Low LVEF suggests serious heart problems.
If your treatments do cause heart problems, ask your doctors to refer you to someone familiar and comfortable with treating heart failure after cancer therapy. Talk to your doctor right away if you have chest pain, breathing problems or any other symptoms of heart trouble during and after your treatment.
Heart trouble can be caused by a number of factors, so knowing if your cancer treatment is affecting your heart is important. Cardiotoxicity, or damage to the heart muscle, needs to be treated right away before the damage becomes severe.
Talk to your doctors right away if you notice symptoms of heart problems. If they believe your treatment is causing the symptoms, they may lower the dose of the medicine causing them, giving them differently, or stop treatment with the medicine.
In some cases, you may be able to manage the symptoms by taking medicines that remove extra fluid from your tissues or that treat heart failure, such as angiotensin-converting-enzymes (ACE inhibitors) or beta-blockers. Oxygen therapy can be given for severe shortness of breath. Taking heart-strengthening medicines often brings heart function back to normal within a few weeks. However, some heart damage can be lifelong.
Here are some more tips to keep your heart healthy during treatment:
- Manage stress. Try relaxation techniques such as yoga, meditation or deep breathing to keep your stress level low. Or treat yourself to a massage.
- Quit smoking and stay away from secondhand smoke.
- Exercise to help you feel more energetic, lessen side effects and help keep your heart healthy and strong.
- Ask your healthcare team about ways to safely and comfortably fit exercise into your care plan.
- Eat healthy, nutritious food. Ask your healthcare team what foods to include or limit to protect your heart. Reduce salt and fat in your diet.
- A nutritionist can help give you strategies for eating well to live well.
- Avoid alcohol or drink in moderation.
- Watch your weight. Being overweight or obese causes your heart to work harder and increases risk of heart disease. It may also increase the risk of other health problems, including diabetes and certain cancers.
- Watch your cholesterol level and blood pressure.
Once your treatment ends, you may still be at increased risk for heart problems because of treatment or personal risk factors. Heart disease is a major cause of death in women over age 65. You should continue to get your heart function monitored on a regular basis. Be sure to discuss this with your doctor.