Cardiology

Chemo Cardiomyopathy

 Chemotherapy generally works by inhibiting growth or function of active tissues within the body. The intent is to slow growth or kill tumor or cancer cells. Since the heart is also composed of active tissue (the heart is constantly pumping), some forms of chemotherapy can weaken the heart.

Most forms of chemotherapy usually do not affect the heart. Those that are may be associated with cardiomyopathy are drugs like daunomycin, doxorubicin or Herceptin, but there are certainly others as well. In most cases, the heart function will recover when holding or stopping the offending agent.

Normal heart function or ejection fraction (EF) is 55-65%, meaning that with each beat, the heart pumps 55-65% of the blood inside the heart to the rest of the body. Cardiomyopathy implies some decrease in EF to less than 50% (which is considered borderline or low normal.)

Symptoms

  • Shortness of breath
  • Edema or swelling
  • Fatigue, especially with exertion
  • Unexplained weight gain
  • Shortness of breath when lying down

Diagnostic Tests


Treatment

  • The typical first step in management is removing the offending agent if possible.
  • Beta-blockers (atenolol, metoprolol, carvedilol, etc) can relax the heart, lower blood pressure and slow the heart to improve filling and pumping function.
  • ACE-inhibitors (lisinopril, enalapril, etc) or ARB’s (losartan, candesartan, etc) can also lower blood pressure, relax the heart and improve blood flow to the kidney.
  • Diuretics may be used to remove excess fluid.
  • Spironolactone can also be used to remove fluid and help relax the heart.
  • Pacemakers or defibrillators may be recommended in some cases.

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