Heart problems

Anyone, even people who have never had cancer, can develop heart problems. However, some cancer treatments can increase the risk. It is important that you recognize and understand symptoms and signs that may indicate heart problems.

What are heart problems?

The heart is a large muscle and consists of a right atrium, right ventricle, left atrium, and left ventricle. The heart pumps oxygen-rich blood from the ventricles through the body. The blood returns to the atria after delivering oxygen throughout the body. Four heart valves ensure that the blood flows in the correct direction.

Sometimes heart problems can develop, such as:

Heart muscle disease (cardiomyopathy): the heart pumps less effectively
Heart rhythm disorders: the heart beats too fast, too slowly, or irregularly
Inflammation of the pericardium (pericarditis)
Heart valve disease: one or more heart valves do not open or close properly
Narrowing of the coronary arteries: insufficient oxygen reaches the heart

There are things you can do to reduce the risk of heart problems, such as maintaining a healthy lifestyle.

Do I have an increased risk of heart problems?

Anyone, including people who have never had cancer, can develop heart problems. However, some cancer treatments can increase the risk.

The following treatments can increase the risk of heart problems:

Radiotherapy (15 Gy or more) to the heart or to an area where the heart is located can cause cardiomyopathy, heart rhythm disorders, pericarditis, or heart valve disease.
Chemotherapy with anthracyclines, such as doxorubicin, daunorubicin, epirubicin, and idarubicin (total dose of 100 mg/m² or more), can cause cardiomyopathy or heart rhythm disorders.
Mitoxantrone can cause cardiomyopathy and heart rhythm disorders.
After radiotherapy in combination with anthracyclines and/or mitoxantrone, the risk of heart problems is higher.

Heart problems occur mainly after high doses, but they can sometimes also develop after low doses. The risk is higher if you were treated at a young age. You can check your treatment summary to see whether you received one or more of these treatments. If you do not have a summary, you can contact the LATER clinic or the hospital where you were treated.

Heart problems are not always caused by treatment. Other causes include high blood pressure, overweight and obesity, impaired glucose metabolism and diabetes, dyslipidemia, smoking, and aging. You also have a higher risk if heart problems are common in your family.

What are symptoms and signs of heart problems?

Certain symptoms and signs may indicate heart problems. Even if you do not have these symptoms at the moment, it is important to recognize them in case you develop them in the future.

Unusual shortness of breath, for example when climbing stairs
Feeling very tired or weak
Dizziness or a light-headed feeling
Difficulty sleeping while lying flat
Needing to urinate frequently at night (more than twice)
Swollen legs, ankles, or feet
Pain or a pressing feeling in the chest
A fluttering sensation in the chest
Excessive sweating

If you recognize one or more of these symptoms or signs, contact your general practitioner or LATER doctor. Early diagnosis and treatment of heart problems are important. If you attend the LATER clinic regularly, heart problems are often detected before symptoms develop.

I have an increased risk of heart problems. Which tests are needed and when?

If you have an increased risk of heart problems, it is recommended to visit your general practitioner or LATER doctor at least every five years. Depending on your treatment, this may need to be more frequent.

Other recommendations include:

Having your blood pressure, blood sugar, and cholesterol levels checked regularly. Your doctor will likely ask whether you smoke, what your weight is, and how much you exercise, as these factors can increase the risk of heart problems.
Having an echocardiogram at least every five years, starting two years after the end of treatment. Depending on the doses of radiotherapy and anthracyclines, more frequent echocardiograms may be needed.
Having an ECG (electrocardiogram) at the first LATER visit and/or after your 18th birthday, at least once in adulthood. The ECG does not need to be repeated for future new symptoms.

If you are a female survivor who wishes to become pregnant or is pregnant and you were treated with anthracyclines and/or radiotherapy to the heart, an additional echocardiogram is recommended:

Before pregnancy according to the schedule below or during the first trimester of pregnancy
If heart problems already exist, in the last trimester of pregnancy and within six months after delivery
If new heart problems are suspected during pregnancy

During visits to your general practitioner or LATER doctor, they may also:

Ask whether you have had heart problems before
Perform a physical examination
Ask about your lifestyle
Order blood tests. Sometimes blood tests can indicate how well the heart is functioning, but further tests are almost always needed to diagnose heart problems.

What happens if I have an increased risk of heart problems?

If you have heart problems, your general practitioner or LATER doctor will likely refer you to a:

Cardiologist (a doctor specialized in heart and blood vessel diseases)

The cardiologist will discuss treatment options with you.

What else can I do?

Knowing that you have (or are at increased risk of) heart problems can be difficult. Talking with friends and family can help. Contact with others in a similar situation can also be supportive, for example through a patient organization such as VOX, part of the Childhood Cancer Association Netherlands.

Take good care of yourself. A healthy lifestyle can reduce the risk of heart problems. Also pay attention to your mental health. Even small changes can have a positive effect on your physical and mental well-being.

It is important to know that you may develop heart problems and to recognize the symptoms and signs. If you have questions or feel worried after reading this information, contact your general practitioner or LATER doctor.

Where can I find more information?

Healthy lifestyle
Mental health

Disclaimer

This information is based on the plain-language summary of the PanCareFollowUp guideline on cardiotoxicity, developed by the PanCare Plain Information Group, which is based on consensus from various national guidelines and the IGHG guideline for cardiomyopathy, and has been adapted where necessary to the Dutch LATER guideline. Do not rely solely on this information if you have symptoms or signs; consult your general practitioner, LATER doctor, or specialist.