16858 Chemotherapy The Heart Cardiotoxicity

Overview

Cardiotoxicity means that cancer treatment, particularly chemotherapy, can damage the heart muscle or affect how well the heart pumps blood. Some chemotherapy medicines can weaken the heart, which may lead to symptoms like tiredness, swelling, or shortness of breath. This condition is sometimes called chemotherapy-induced cardiotoxicity or chemotherapy-related heart problems.

Cardiotoxicity from chemotherapy is not very common, but it does happen. The risk depends on the type and dose of chemotherapy, as well as your age and whether you already have heart problems.

It can affect anyone receiving chemotherapy, but it is more likely in people who are older, have high blood pressure or existing heart disease, or receive certain types of chemotherapy or high doses. People who have had radiation therapy to the chest are also at higher risk.

Symptoms

Common symptoms

• Shortness of breath, especially during activity or when lying down
• Unusual tiredness or fatigue
• Swelling in the legs, ankles, or feet
• Feeling your heart race, pound, or skip beats
• Lightheadedness or dizziness
• Chest pain or discomfort

Symptoms in children

• Unusual tiredness or less energy during play
• Faster breathing or difficulty breathing during feeding or activity
• Poor appetite or slow weight gain
• Excessive sweating, especially during feedings
• Swelling around the eyes or in the legs

Symptoms in older adults

• Symptoms may be mistaken for normal aging, such as feeling more tired or getting short of breath with activity
• New or increased swelling in the feet or ankles
• Confusion or reduced alertness due to low blood flow
• Unexplained weight gain from fluid retention

Causes

Main causes

• Certain chemotherapy drugs can directly damage the cells of the heart muscle
• Chemotherapy may cause inflammation in the heart, leading to weakened heart function
• Some cancer treatments can increase blood pressure or cause blood clots, putting extra strain on the heart
• Radiation therapy to the chest, if given, can also add to heart risk

Risk factors

• Already having heart disease or high blood pressure
• Being older than 65
• Receiving high doses of chemotherapy or certain combinations of drugs
• Having had radiation therapy to the chest area
• Smoking, diabetes, or high cholesterol
• Having a history of heart failure or heart attack

When to see a doctor

See a doctor urgently if:

• If you have sudden chest pain, severe breathlessness, fainting, or a very irregular heartbeat, call your local emergency number now.
• If you have swelling, fatigue, or shortness of breath that is getting worse, tell your cancer care team or GP the same day.

Book a routine appointment if:

• If you notice new symptoms like mild swelling, tiredness, or feeling your heart pound, make an appointment with your GP or oncologist.
• If you are scheduled for chemotherapy, make sure you attend all heart check appointments before and during treatment.

Diagnosis

Cardiotoxicity is diagnosed by your doctor after listening to your symptoms, examining you, and reviewing tests that check how well your heart is working. Your cancer care team will often arrange these tests before you start chemotherapy, and again during or after treatment, to compare your heart function over time.

Tests that may be done

• Echocardiogram, an ultrasound of the heart that shows how well it pumps
• Electrocardiogram (ECG or EKG) to check the heart's rhythm
• Blood tests to look for substances that may indicate heart strain or damage
• Heart MRI (magnetic resonance imaging) in some cases for a closer look at the heart muscle

What to expect at your appointment

Your doctor will ask about your symptoms and your medical history. You will likely have a physical exam that may include an electrocardiogram. The main test is an echocardiogram, which is painless and uses sound waves to create a picture of your heart. You may need to have these tests before treatment and repeat them after certain cycles of chemotherapy. The results help your team decide if your cancer treatment needs to be adjusted and if your heart needs extra support.

Treatment

If chemotherapy affects your heart, the first step is to talk with your cancer care team. They will work together with heart specialists to plan the best care. Treatment focuses on protecting your heart, easing symptoms, and helping you continue your cancer treatment as safely as possible.

Self-care at home

• Tell your doctor right away about any new or worsening symptoms
• Control blood pressure and blood sugar with healthy habits and prescribed medicines
• Limit salt to reduce swelling and fluid build-up
• Avoid alcohol and do not smoke
• Stay active within the limits recommended by your care team

Medical treatments

Your doctor may prescribe medicines that help your heart pump better, lower blood pressure, or remove extra fluid. These are common heart medications, and they are chosen carefully for your situation. In some cases, your cancer treatment plan may be adjusted—for example, lowering the dose or changing to a different chemotherapy drug—to reduce the risk to your heart. Always take any medication exactly as prescribed and ask your healthcare team if you have questions.

When is surgery considered?

Surgery is rarely needed for chemotherapy-related heart damage. It may be considered if you have a specific heart problem, such as a damaged heart valve, that needs repair. Most of the time, cardiotoxicity is managed with medicines and lifestyle support rather than surgery.

Living with this condition

Living with the risk of heart problems during cancer treatment can feel overwhelming, but you can take small steps to protect your heart. Keep a record of any new symptoms and share it with your healthcare team. Attend all heart check appointments, and don't be afraid to ask questions.

Lifestyle tips

• Stay as active as you can—gentle walking or light exercise often helps
• Rest when you need to, especially if you feel tired
• Weigh yourself regularly to detect sudden fluid build-up
• Manage stress with calm breathing, relaxation, or talking to someone you trust
• Keep up with regular blood pressure checks

Diet and exercise

Eat a heart-healthy diet with plenty of fruits, vegetables, whole grains, and lean proteins. Try to limit high-fat, salty, and sugary foods. Exercise is good, but it should be adjusted to how you feel. A short walk every day, gentle stretching, or light yoga can be helpful. Always check with your care team before starting a new exercise routine, especially if you have heart issues.

Mental health and emotional wellbeing

Being diagnosed with cancer and then worrying about heart problems can cause anxiety, stress, or low mood. These feelings are normal. It is important to talk about them with someone you trust. Your GP or cancer center can also point you to counseling or support groups. Remember, taking care of your mental health is part of taking care of your heart.

Prevention

Not all heart problems from chemotherapy can be prevented, but the risk can be lowered. Doctors carefully check your heart before starting treatment and watch it during chemotherapy. Managing blood pressure and other risk factors, staying active, and eating well all help reduce the chance of heart problems.

Vaccines

Talk to your doctor about staying up-to-date with recommended vaccines, such as flu and pneumonia vaccines, because infections can put extra stress on your heart. Your doctor can tell you which vaccines are safe for you during cancer treatment.

Screening programmes

Screening for cardiotoxicity means having regular heart function tests, usually an echocardiogram, before and during chemotherapy. These tests help spot any early changes so treatment can be adjusted in time. If your doctor recommends these checks, it is important to attend them.

Complications

If left untreated

• Heart failure, where the heart becomes too weak to pump enough blood
• Irregular heart rhythms that may cause palpitations or dizziness
• High blood pressure or problems with blood clotting
• Fluid build-up in the lungs or legs
• Long-term damage that reduces quality of life

Long-term outlook

Many people who experience chemotherapy-related heart problems get better with the right care. Finding heart issues early is the best way to protect your long-term health. Even if your heart is affected, treatments can improve your heart function, and your cancer care can be adjusted to be safer. With close monitoring and good support, many people continue their cancer treatment and go on to live healthy, fulfilling lives.

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