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Chemotherapy-induced Heart Failure- Cardiology Bias
Chemotherapy-induced heart failure (CIHF) is a serious side effect caused by cardiotoxic chemotherapy taken by the cancer patient. The article linked and excerpted below makes it sound as though this side effect is inevitable. It need not be.
I know this because I underwent aggressive chemo (induction, ASCT) in ’95.’96, and was diagnosed with chemotherapy-induced heart failure in late 2010.
What FDA approved chemotherapies can damage the patient’s heart?
- Anthracyclines: Drugs like doxorubicin, daunorubicin, and epirubicin are commonly used in chemotherapy for various cancers. They are effective against cancer cells but can also cause damage to the heart muscle, leading to conditions like cardiomyopathy and heart failure.
- Trastuzumab (Herceptin): This targeted therapy is used to treat breast cancer that is HER2-positive. While effective against cancer, trastuzumab can sometimes lead to heart problems, including heart failure.
- Tyrosine kinase inhibitors (TKIs): Drugs like imatinib, sunitinib, and dasatinib are used to treat certain types of leukemia and other cancers. They can sometimes cause heart problems such as hypertension, heart failure, and heart rhythm disturbances.
- Immune checkpoint inhibitors: Drugs like pembrolizumab, nivolumab, and ipilimumab are immunotherapy agents used to treat various cancers. While they boost the immune system’s ability to fight cancer, they can also lead to immune-related adverse events, including inflammation of the heart muscle (myocarditis) and other cardiac issues.
- Proteasome inhibitors: Drugs like bortezomib and carfilzomib are used to treat multiple myeloma and some other cancers. They can sometimes cause heart rhythm disturbances and heart failure.
- Radiation therapy: While not a drug, radiation therapy aimed at treating cancer can also inadvertently damage the heart, particularly when the tumor is located near the heart. This can lead to conditions such as coronary artery disease, pericarditis, and cardiomyopathy.
Conventional cardiology’s answer, invariably, is drugs, drugs and more drugs. These drugs often bring even more side effects. I was prescribed metoprolol when I was diagnosed. I had a reaction to this drug and researched non-toxic therapies.
“Several classes of drugs improve the heart’s function, including ACE inhibitors, beta blockers and angiotensin receptor blockers (ARBs). The combination drug sacubitril/valsartan is the first FDA-approved medication in a new class known as angiotensin receptor neprilysin inhibitors (ARNis).”
If you are considering undergoing one or more cardiotoxic regimens, consider pursuing conventional prevention strategies as well as evidence-based non-conventional strategies including:
I think you might benefit from an integrative approach too. A small dose of conventional meds with non-conventional therapies supporting each other.
If you would like to discuss chemotherapy-induced heart damage further, email me at David.PeopleBeatingCancer@gmail.com
Good Luck,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
- CoQ10 to Improve Ejection Fraction in Congestive Heart Failure
- Lasix Side Effects-Is Furosemide Necessary for Stable Heart Failure?
- Multiple Myeloma Side Effects- CoQ10 Prevents Chemo Cardiotoxicity
AHA News: Millions Are Learning to Live With Heart Failure
“MONDAY, FEB. 3, 2020 (American Heart Association News) — It was almost six years to the day after Aimee Rodriguez-Zepeda completed her chemotherapy that doctors listened to her heart and gave her the bad news.
“I was exhausted,” she said. “They found my heart was only working at 20% capacity.” Her condition – heart failure (chemotherapy-induced cardiomyopathy) – was likely caused by the chemotherapy that saved the former Marine from uterine cancer, combined with a family history of heart disease and stroke.
“People don’t understand that while the idea of chemo is to make you better, a lot of the medications they use wreak havoc on your body,” said Rodriguez-Zepeda, who was 39 at the time of her heart failure diagnosis in 2014. “I was a ticking time bomb.”
But not anymore, thanks to improved medical care and advances in technology. Heart failure, once considered a death sentence, can now be managed for years – even decades – with lifestyle changes, medication, implantable devices or surgery.
It is now considered a chronic condition, said Dr. Anjali Tiku Owens, a heart failure and transplant cardiologist at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “How long a patient will survive is incredibly variable…”
The most common causes are heart attacks, heart diseases and defects, high blood pressure, lung conditions and alcohol or drug abuse. Diabetes also increases the risk for developing heart failure, and some cancer treatments such as chemotherapy and chest radiation can as much as double the risk.
While many factors affect the rising prevalence, one is simply that people are living longer, said Dr. Shannon Dunlay, an advanced heart failure and transplant cardiologist at the Mayo Clinic in Rochester, Minnesota.
“We know the risk of heart failure goes up as we age,” she said.
There’s a lot doctors and other health care providers can do to help patients manage the condition.
“The cornerstone of treatment is medication,” Owens said.
Several classes of drugs improve the heart’s function, including ACE inhibitors, beta blockers and angiotensin receptor blockers (ARBs). The combination drug sacubitril/valsartan is the first FDA-approved medication in a new class known as angiotensin receptor neprilysin inhibitors (ARNis)…
Both Dunlay and Owens say one of the most important ways to treat heart failure is through lifestyle changes. Indeed, Rodriguez-Zepeda credits changes to her diet and exercise regimen as being the most beneficial in managing her condition.
“Patients have a lot to deal with,” Dunlay said. “They have to take medications at specific times each day, exercise and monitor fluid intake as well as their weight. We like patients to weigh themselves every morning. If weight goes up by more than five pounds, they have to call us and see if we need to adjust their medications. Excess weight is one of the main signals that they may be retaining extra fluid.”
People with severe heart failure can benefit from implantable devices, such as defibrillators that shock the heart back into rhythm or pacemakers that help the heart pump more efficiently. Doctors also can implant tiny sensors into the pulmonary artery that can be monitored remotely, alerting them when the pressure begins to rise, an early sign that a patient’s lungs could be filling with fluid.
One of the major advances of the past few decades is a mechanical heart pump that attaches to the left ventricle, the heart’s major pumping station, enhancing or replacing the function of the left side of the heart, Dunlay said.
The device operates on a battery pack during the day and can be plugged in at night through a cord coming out of the patient’s upper abdomen. “While these have been around a while, they’re getting smaller and hopefully soon we’ll have a completely implantable one,” she said.
For some people, when medications, lifestyle changes and other procedures won’t suffice, a heart transplant may be the only hope, Owens said. But these are still rare.
The goal of all the treatment and advances, Owens said, is making sure patients aren’t just living longer but are living well.
“Are they living life to the fullest, or constantly in and out of the hospital? Once someone is diagnosed with heart failure, we need to have ongoing conversations about the goals of care to make sure we are also focused on their quality of life.”
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