Heart Problems Caused by Cancer Treatment

Aprobado por la Junta Editorial de Cancer.Net, 10/2021

Heart problems are an uncommon but serious side effect of some cancer treatments. The medical term "cardiac toxicity" refers to this type of side effect.

Heart problems caused by cancer treatment can:

  • Affect the dose or type of cancer treatment you receive

  • Affect your quality of life

  • In rare cases, cause death

Only some cancer treatments are linked with heart problems. Knowing whether you are at risk of developing heart problems can help. And, there are ways to prevent or manage these side effects.

Relieving side effects is an important part of cancer care. This type of care is called palliative care or supportive care. It helps people with any type or stage of cancer feel better. Talk with your health care team about your risk of heart problems and the cancer treatment recommended for you.

What are common symptoms of heart problems?

People experiencing heart problems may have these symptoms:

If you notice any of these symptoms, contact your health care team right away. It is also important to let them know of any new or changing symptoms over time.

Types of heart problems caused by cancer treatment

Cancer treatments can cause heart problems such as:

  • Cardiomyopathy and congestive heart failure (CHF). Cardiomyopathy is caused by damage to the heart that makes it unable to pump blood well. When cardiomyopathy worsens and the body's organs do not get enough oxygen, it is called congestive heart failure.

  • Myocarditis is swelling of the heart that can affect the heartbeat. It can lead to other heart problems.

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

  • Arrhythmia is an irregular heartbeat.

  • Damage to heart valves, which causes the valves to narrow and stiffen or leak.

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

What cancer treatments causes heart problems?

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

Anthracycline chemotherapies. A type of chemotherapy called anthracycline can cause heart problems. Examples include:

  • Daunorubicin (Cerubidine)

  • Doxorubicin (Adriamycin, Doxil)

  • Epirubicin (Ellence)

  • Idarubicin (Idamycin)

  • Valrubicin (Valstar)

Other chemotherapy drugs. Mitoxantrone (Novatrone) and tucatinib (Tukysa) can cause heart problems. Cisplatin (Platinol) can cause severe high blood pressure, which can lead to heart problems.

Radiation therapy to the chest. Higher doses to large areas of the heart cause more heart problems. A combination of radiation therapy and chemotherapy can increase this risk.

Some types of targeted therapy. Many different targeted therapies can cause heart problems or high blood pressure. Examples include:

  • Axitinib (Inlyta)

  • Bevacizumab (Avastin)

  • Dasatinib (Sprycel)

  • Lapatinib (Tykerb)

  • Pazopanib (Votrient)

  • Sorafenib (Nexavar)

  • Sunitinib (Sutent)

Ask your health care team about the risk of heart problems with any of these treatments and the risk of heart problems in general based on the cancer treatment plan recommended for you.

Risk factors for heart problems caused by cancer treatments

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

  • Lab and imaging tests

  • Discussion of your health history

How are heart problems caused by cancer treatment diagnosed?

During or after cancer 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.

During a physical exam, your 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.

Other tests to diagnose heart problems:

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

  • Multigated acquisition (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) 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 can detect certain signs of heart damage.

  • An angiogram takes a picture of your 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.

  • A chest x-ray takes a picture of the inside of the chest.

  • An electrocardiogram (EKG, ECG) 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 in cancer survivors

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 in adult cancer survivors. (Please note this link takes you to another ASCO website.) An echocardiogram is the primary recommended test. 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.

Reducing the risk of heart problems from cancer treatment

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 cancer medications cause heart problems. There may be other 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.

Managing heart problems

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

Learn more about managing heart problems during cancer treatment.

Questions to ask the health care team

  • Do any of the recommended cancer treatments cause heart problems?

  • Are there other effective treatments that are less likely to cause heart problems?

  • What symptoms of high blood pressure or heart problems should I watch for?

  • Who should I tell if I have any new symptoms of heart problems? How soon?

  • How often should my blood pressure and heart be checked during cancer treatment? Should I monitor my blood pressure at home?

  • What should my blood pressure numbers be?

  • What blood pressure numbers are too high or too low for me?

  • What types of screening tests will be used to monitor my heart during and after cancer treatment?

  • How long after cancer treatment will my blood pressure and heart need to be monitored?

Related Resources

Long-Term Side Effects of Cancer Treatment

Side Effects of Chemotherapy

Side Effects of Radiation Therapy

More Information

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

Children’s Oncology Group: Heart Problems

American Heart Association: Health Topics