Symptoms of Chemotherapy-induced Heart Damage- PeopleBeatingCancer

Symptoms of Chemotherapy-induced Heart Damage-

What are the symptoms of chemotherapy-induced heart damage aka chemotherapy-induced cardiomyopathy(CIC)? When this side effect happened to me, I didn’t notice a thing until I flipped into atrial fibrillation. 15 years almost to the day, when I completed an ASCT.

Yet I read about MM patients experiencing possible CIC symptoms frequently. It is difficult to tell if a NDMM patient is experiencing CIC symptoms or not. I’m sure that I experienced symptoms sometime during the 15 years after my ASCT but before my heart flipped into chronic Afib.

An Overview of Chemotherapy-Induced Heart Failure

What chemotherapy regimens for myeloma can damage the heart?

1. Anthracyclines (e.g., Doxorubicin, Liposomal Doxorubicin)

Mechanism: Anthracyclines can cause direct damage to heart muscle cells, leading to cardiomyopathy and heart failure.
Risk Factors: Higher cumulative doses, pre-existing heart disease, and concurrent use of other cardiotoxic agents.
Monitoring: Regular cardiac imaging (e.g., echocardiography or MUGA scans) to assess left ventricular ejection fraction (LVEF).

2. Proteasome Inhibitors (e.g., Carfilzomib, Bortezomib)

Carfilzomib: Has been associated with hypertension, heart failure, and ischemic events. The risk appears higher with higher doses or in patients with existing cardiovascular risk factors.
Bortezomib: Rarely associated with cardiac complications but can occasionally cause heart failure or arrhythmias.

3. Immunomodulatory Drugs (e.g., Lenalidomide, Thalidomide, Pomalidomide)

Thalidomide: Known to increase the risk of blood clots, which can lead to heart attacks or strokes.
Lenalidomide and Pomalidomide: Less thrombogenic than thalidomide but still require anticoagulation in patients with additional risk factors.

4. Alkylating Agents (e.g., Melphalan, Cyclophosphamide)

While less commonly cardiotoxic, high doses of alkylating agents used in stem cell transplantation can sometimes lead to pericarditis or arrhythmias.

5. Corticosteroids (e.g., Dexamethasone, Prednisone)

These are not directly cardiotoxic but can exacerbate hypertension, fluid retention, and arrhythmias, indirectly affecting heart health.

6. Monoclonal Antibodies (e.g., Daratumumab, Elotuzumab)

Typically not directly cardiotoxic but may cause infusion-related reactions that mimic cardiac symptoms, such as chest tightness or palpitations.

What are the symptoms of chemotherapy-induced cardiotoxicity?

1. General Symptoms

Fatigue: Persistent tiredness or lack of energy.
Shortness of breath: Difficulty breathing, especially during physical activity or while lying down.
Swelling: Edema, particularly in the legs, ankles, feet, or abdomen.
Chest pain: Discomfort or pain in the chest, which may mimic angina.
Palpitations: Irregular or fast heartbeat.

2. Symptoms Specific to Heart Failure

Coughing or wheezing: Often worse at night or while lying down.
Rapid weight gain: Due to fluid retention.
Decreased exercise tolerance: Feeling exhausted or breathless even with minimal activity.

3. Symptoms Related to Arrhythmias

Dizziness or lightheadedness
Fainting or near-fainting episodes
Fluttering sensation in the chest

4. Symptoms of Myocardial Ischemia or Infarction

Persistent chest discomfort or pain
Pain radiating to the jaw, arm, or back
Nausea, sweating, or cold sweats

Key Drugs Associated with Cardiotoxicity

Certain chemotherapy agents have a higher risk of causing cardiotoxicity:

Anthracyclines (e.g., doxorubicin, daunorubicin): Associated with dose-dependent heart failure.
Trastuzumab: Can cause reversible left ventricular dysfunction.
Tyrosine kinase inhibitors (e.g., sunitinib, imatinib): May lead to hypertension and heart failure.
Fluoropyrimidines (e.g., 5-FU, capecitabine): Can cause coronary vasospasm.

When to Seek Medical Attention

If you or someone undergoing chemotherapy experiences any of these symptoms, it’s crucial to consult a healthcare provider promptly. Early detection and management can mitigate long-term complications. Regular monitoring with echocardiograms or other cardiac assessments is often recommended during and after chemotherapy for high-risk patients.

The most important takeaway from this post should be be that during the time I’ve been researching and writing about CIC, oncology has posted research documenting CIC occurring:

5%-10% then
10%-20% then
almost 30% of the time

I’m not saying that oncology was lying about CIC, I’m saying that oncology doesn’t study the long-term side effects of of toxic treatments and that CIC is the very definition of a late stage side effect.

As for therapies to protect the heart from CIC, I have managed my own afib by undergoing many different evidence-based but non-conventional heart therapies such as exercise, heart healthy nutrition and heart healthy supplementation.

Email me at David.PeopleBeatingCancer@gmail.com with questions about symptoms of chemotherapy-induced heart damage.

Thank you,

David Emerson

MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Chemotherapy Induced Cardiomyopathy: Pathogenesis, Monitoring and Management

…Chemotherapies varies in their incidence of inducing cardiomyopathy, and the onset which may occur acutely (during or shortly after treatment), sub-acutely (within days or weeks after completion of chemotherapy) or chronically (weeks to months after drug administration).

Cardiac events associated with chemotherapy may consist of:

mild blood pressure changes,
thrombosis,
Electrocardiographic (ECG) changes,
arrhythmias,
myocarditis,
pericarditis,
myocardial infarction,
cardiomyopathy,
cardiac failure (left ventricular failure),
and congestive heart failure (CHF).

symptoms of chemotherapy-induced heart damage

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