Risk for Cardiac (Heart) Problems Related to Anthracycline Chemotherapies After Childhood Cancer

Dava Szalda, MD MSHP
Last Modified: June 5, 2016

What is the risk?

The group of chemotherapy agents called anthracyclines are known to cause cardiac toxicities, including cardiomyopathy, left ventricular dysfunction (weakening of the heart muscle), arrhythmias (rhythm abnormalities), and heart valve problems. Anthracyclines include doxorubicin, daunorubicin, idarubicin, and mitoxantrone. Toxicity can develop anywhere from shortly after completing chemotherapy, to decades later, making heart health an important consideration for all cancer survivors. The risk of developing one of these heart problems is tied to the total dose of the chemotherapy a person has received, whether you are male or female, and the age at which you received the medication. In general, higher doses mean higher risk. Survivors who were younger in age at the time of treatment and females are thought to be at a slightly higher risk.

Things like anesthesia, or pregnancy in women, can cause extra stress on the heart, so a cardiac assessment should be done prior to any planned surgery or with pregnancy. In addition, history of coronary artery disease, other heart disease, or hypertension (high blood pressure) increase the risk of developing heart problems.

Risk is further increased for those survivors who also received radiation to the chest. Radiation, even without chemotherapy, can cause early coronary artery disease, which increases the risk for heart attack.

The Children’s Oncology Group Long-Term Follow Up Guidelines give recommendations for heart testing based on exposures.

Symptoms/ When to Call

Cardiac toxicities can cause symptoms such as shortness of breath (with or without exertion), orthopnea (difficulty breathing when lying down), chest pain, palpitations, exercise intolerance, dizziness/lightheadedness, or edema (swelling of the extremities). Annual history and physical by a healthcare provider should include a cardiac exam and review of possible symptoms.

Prevention and Treatment

There are ways you can help keep your heart healthy, including maintaining a healthy lifestyle, by avoiding smoking and drug use. Maintaining a healthy weight, getting regular physical activity, and eating a diet high in fruits and vegetables are important parts of being heart healthy. Weight, blood pressure and cholesterol should be monitored by your medical team.

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