Heart Health After Childhood Cancer

Most childhood cancer survivors don’t develop heart problems. But certain types of chemotherapy and radiation can raise your risk for them. Here’s what you need to know to assess your risk and help keep your heart healthy.

Am I at Risk?

Survivors who received a type of chemotherapy called anthracyclines or radiation to the chest, spine, stomach, or whole body are at risk for heart problems. Risk is highest for those who had high treatment doses, especially if both chemotherapy and radiation were given before puberty.

These treatments can damage the heart and cause the following problems:

  • the heart doesn’t contract and relax as it should
  • the heart beats too fast, too slow, or irregularly
  • heart valves or blood vessels are stiff or leak
  • the protective covering of the heart is inflamed or scarred
  • heart blood vessels are scarred or blocked 

If severe, these problems can be deadly. But very few survivors develop severe heart problems. In fact, most survivors who received anthracyclines or radiation to the heart or nearby areas don’t have any heart damage at all. Others have very mild changes in heart function or size that doesn’t worsen over time.

What Are the Symptoms of Heart Problems?

Mild to moderate heart problems may not have any symptoms. Symptoms of more severe heart trouble include the following:

  • shortness of breath
  • dizziness
  • feeling lightheaded, fainting, or near-fainting
  • severe fatigue that keeps you from exercise or normal activities
  • chest pain that travels to your arm, chin, or face
  • sweating, nausea, or shortness of breath with chest pain
  • very swollen feet or ankles
  • cough and wheeze that doesn’t go away
  • periods of heart racing or throbbing
  • feeling like your heart is skipping beats

Be sure to tell your doctor right away if you have any of these symptoms.

What Can I Do to Keep My Heart Healthy?

The good news is that you can lower your risk for heart problems by keeping a healthy lifestyle, such as:

  • not smoking,
  • keeping a healthy weight,
  • limiting fat in your diet,
  • exercising for at least 30 minutes on most days, and
  • keeping diabetes, high blood pressure, or high cholesterol under control, if you have them.

It’s also important to keep up with your regular medical check-ups so that any heart problems can be caught and treated early. Thus, if you were treated with anthracyclines or chest radiation you should have a yearly check-up. In addition, you’ll undergo certain heart tests, such as electrocardiograms or MUGA scans, every 1 to 5 years. Finally, you might also undergo periodic stress testing by a cardiologist and regular blood tests to check for other factors that can put you at risk.

What Should I Talk to My Doctor About?

Make sure that your primary care doctor knows if you were treated with anthracyclines or chest radiation so that steps can be taken to reduce stress on your heart. Some drugs, high fever, and pregnancy can increase stress on the heart.

  • Tell your doctor if you are pregnant or planning to get pregnant. You might need to be seen by a cardiologist because of the extra strain placed on the heart during pregnancy.
  • Check with your doctor before starting an exercise program. You might need to be monitored by a cardiologist if you plan to do strenuous exercise or varsity team sports.
  • If you have damaged heart valves or active chronic graft-versus-host disease, ask you doctor if you need to take antibiotics before dental and other medical procedures to prevent infection in the heart.

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