Heart Problems

Approved by the Cancer.Net Editorial Board, 10/2018

Heart problems are uncommon but serious side effects of some cancer treatments. The term "cardiac toxicity" refers to these side effects. Heart problems can do the following:

  • Affect treatment

  • Lower a person’s quality of life

  • Cause death, rarely

Only certain cancer treatments are linked with heart problems. And there are ways to prevent or manage these side effects.

Relieving side effects is an important part of cancer care. This approach is called palliative care or supportive care. Talk with your health care team about any new symptoms or changes in symptoms.

Symptoms of heart problems

People experiencing heart problems may have these symptoms:

  • Shortness of breath

  • Lightheadedness or dizziness

  • Discomfort or pain in the chest

  • Fatigue

  • Swollen hands and/or feet

If you notice any of these symptoms, contact your health care team right away.

Types of heart problems

Below is a list of heart conditions that could develop after cancer treatment:

Cardiomyopathy and congestive heart failure (CHF). This is damage to the heart that makes it unable to pump blood well.

Myocarditis. This is swelling of the heart that can affect the heart beat.

Coronary artery disease. This is a blockage or scarring of the blood vessels of the heart.

Arrhythmia. This is an irregular heartbeat.

Damage to heart valves. This causes the valves to narrow and stiffen or leak.

Problems with the pericardium. The pericardium is the outer membrane of the heart. Problems may include swelling (pericarditis) or thickening or scarring (pericardial fibrosis).

Causes of heart problems

The following cancer treatments are more likely to cause heart problems:

  • Chemotherapy with drugs called anthracyclines, including daunorubicin (Cerubidine), doxorubicin (Adriamycin, Doxil), epirubicin (Ellence), idarubicin (Idamycin), and valrubicin (Valstar)

  • Chemotherapy with certain other drugs, such as mitoxantrone (Novantrone)

  • Radiation therapy to the chest

  • Some types of targeted therapy, including bevacizumab (Avastin), trastuzumab (Herceptin), lapatinib (Tykerb), sunitinib (Sutent), and sorafenib (Nexavar)

Risk factors for heart problems

Some people may have a higher risk of heart problems, including:

  • People 60 and older, young children, and women

  • People who received high doses of anthracyclines

  • People who had high-dose radiation therapy to the chest

  • People who had a combination of anthracyclines and radiation therapy to the chest

  • People who received anthracyclines or trastuzumab and have a history of smoking, high blood pressure, diabetes, obesity, or heart problems

  • People who received anthracyclines followed by trastuzumab

Your doctor will weigh the risks and benefits before recommending cancer treatments. Recommendations are based on information gathered through:

  • A physical exam

  • Other tests

  • Discussion of your health history

Diagnosing heart problems

During or after treatment, your doctor may perform tests to find heart problems and identify the cause.

Depending on the test results or the tests needed, your doctor may refer you to a cardiologist. A cardiologist is a doctor who specializes in diagnosing and treating heart conditions.

You may receive the following tests:

Physical exam. The doctor listens to your heart beat or the sound of blood moving through the major vessels in the neck. During this test, the doctor looks for usual sounds or changes to your heart beat. These may be a sign that further tests are needed.

Echocardiogram (echo). An ECHO uses sound waves and an electronic sensor to look at the heart's structure and function.

Multigated acquisition (MUGA) scan. A MUGA scan creates video images of the lower chambers of the heart that hold blood. These chambers are called “ventricles.” A MUGA scan checks whether the ventricles are pumping blood properly.

Cardiac Magnetic Resonance Imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A cardiac MRI takes images of the heart. Before the scan, the patient receives an injection of a special dye. The dye is called a contrast medium. And it creates a clearer picture.

Blood tests. Certain signs of heart damage may show up in the blood. Your health care team can test for these.

Angiogram. This procedure takes a picture of the blood vessels. First, you will receive a dye, injected into the artery. Then, the doctor examines the artery with a special x-ray device called a fluoroscope.

Chest x-ray. A chest x-ray is a picture of the inside of the chest.

Electrocardiogram (EKG, ECG). An EKG records the electrical activity of different areas of the heart as wavy lines on a piece of paper. This can show abnormal heart rhythms or heart damage.

Watching for heart problems

Your doctor may check for heart problems even if you do not have symptoms. This is especially important for people who have a higher risk.

The American Society of Clinical Oncology (ASCO) provides recommendations for monitoring for heart problems. An echocardiogram is the primary recommended test. But you may also undergo a cardiac MRI or a MUGA scan. Testing may be done periodically during treatment and/or 6 to 12 months after cancer treatment ends.

Preventing and managing heart problems

Your health care team may recommend steps to reduce the risk of heart problems from cancer treatment. Possible options include:

Giving a different drug. Not all drugs cause heart problems. There may be equally effective drugs available that are not linked to heart problems.

Reducing the dose or giving the drug in a different way. You may be able to receive a lower dose that still effectively treats the cancer but is less likely to affect the heart. Your doctor may also recommend a different method for giving the drug. Sometimes, a different method reduces heart damage.

Giving additional drugs that could help protect your heart. The drug dexarazoxane (Zinecard) can help prevent heart problems from anthracyclines. Researchers are studying other drugs to help prevent heart damage.

Reducing radiation therapy to the heart. This may include using a lower dose. Other techniques include:

  • Deep inspiration breath holding. This is used to avoid unnecessary radiation exposure to the heart. It involves taking a deep breath and holding it for short periods while the radiation is given.

  • Intensity modulated radiation therapy (IMRT). This is a type of radiation therapy that directs the radiation dose at the tumor by varying the intensity of the beam.

If you develop a heart problem after cancer treatment, your doctor may recommend medication to manage it. These could include 1 or more of the following:

  • Diuretics, which are medications that eliminate excess fluid from the body by increasing urination

  • Blood pressure medications, such as ACE inhibitors or beta-blockers

  • Digitalis, which helps regulate the heart beat

Related Resources

Long-Term Side Effects of Cancer Treatment

Side Effects of Chemotherapy

Side Effects of Radiation Therapy

More Information

American Heart Association: Health Topics

American Society of Echocardiography: Heart Information for the Cancer Patient (PDF)

Children’s Oncology Group: Heart Problems