Heart Health & Cancer

Cardio-oncology support for cancer patients

Expert Cardio-Oncologists

The Cardio-Oncology Program at Beth Israel Deaconess Medical Center (BIDMC) brings together cardiologists and oncologists. We can help you minimize adverse effects on your heart that may result from cancer therapies, including radiation therapy.

Understanding Cardiac Toxicity

Cancer treatment can have both short- and long-term effects on your heart. Cardiotoxicity is damage to the heart caused by cancer therapies. Cardiotoxicity can become more life-threatening than the cancer itself.

Our team participates in research to improve heart health for people who’ve had cancer. This research gives you access to the latest and safest therapies.

Cardiomyopathy

The most common form of cardiac toxicity that chemotherapy can cause is weakening of the muscle tissue responsible for the heart’s pumping function. This condition of reduced pumping strength is called cardiomyopathy. Cardiomyopathy can result in these and other symptoms:

Fatigue
Fluid retention

Shortness of breath with light physical activity
Trouble with physical exertion

Together, these symptoms comprise a syndrome that doctors call heart failure.

Other Types of Cardiotoxicity

Other forms of cardiotoxicity include:

Inflammation of the sac that surrounds the heart (pericarditis), which can result in dangerous accumulation of fluid around the heart.
Trouble with the conduction of the electrical impulses among the four heart chambers, which can result in slowing of the heart beat and reduced pumping.
Blockage of the coronary arteries, which can lead to a heart attack.
Damage to the heart valves, which can lead to blocked blood flow, or backflow, across the valves.

Types of Chemotherapy that Cause Heart Damage

Only a small number of cancer drugs have the potential for major cardiac side effects. However, these include some of the most powerful and effective anticancer agents:

Doxorubicin (Adriamycin)
Trastuzumab (Herceptin)
Cyclophosphamide (Cytoxan)

Oncologists use these chemo drugs to treat a wide variety of cancers, including those of the breast, colon and blood.

Because these agents are so effective in treating the target cancer, our care teams generally accept the potential for cardiotoxicity as a risk worth taking. Also, we now have a good understanding of the risk factors and doses that are associated with cardiotoxicity. Our teams can modify risk factors and dosing to minimize your risk of damage to the heart as a result of potentially lifesaving chemotherapy.

Types of Radiation that Cause Heart Damage

Radiation therapy directed to the chest can cause heart damage when the radiation oncologist gives it in high doses. However — to the best extent possible — the care team physically shields your heart from the radiation beam. This helps minimize exposure of the heart.

Specialized Heart Programs

To serve your unique heart needs, we offer a number of specialized heart programs:

Advanced Heart Failure Program: This program brings together a multidisciplinary team of cardiologists and cardiac surgeons. They are experts in diagnosing and treating all stages of heart failure using the latest medical advances.
Amyloidosis Clinic: Heart failure specialists and cardio-oncologists manage cardiac amyloidosis. This clinic offers technetium pyrophosphate (PYP) scanning, cardiac MRI, endomyocardial and bone marrow biopsy.

Services We Offer

Our goal is to help you reduce your risk of cardiotoxicity and avoid stopping effective cancer therapies. The sooner we diagnose cardiotoxicity, the more we can do to potentially reverse it. We see patients in Boston, Lexington, Needham and Plymouth.

Before Cancer Treatment

We evaluate you for cardiovascular risk in relation to the benefit of your recommended cancer treatment. We can provide cardiovascular therapies that reduce risk. Our goal is to maximize your well-being and long-term outcome.

Your oncologist and/or radiation oncologist will inform you of the potential for cardiotoxicity of any cancer treatment that’s part of your care plan. They may refer you to a cardiologist with expertise in assessing and treating cancer patients at risk for heart damage.

Pre-Existing Heart Conditions

If you have a pre-existing heart condition, you should receive an exam from a cardio-oncologist before beginning any cancer treatment. Such heart conditions can include these and others:

Cardiomyopathy
Coronary artery disease
Heart valve dysfunction
Irregular heartbeat
Prior heart attack
Uncontrolled hypertension (high blood pressure)

During Cancer Treatment

To quickly detect any damage to the heart muscle, we monitor the impact of your cancer treatment using non-invasive imaging:

These imaging tests provide details on important factors:

Blood flow
Blood pressure within the chambers of the heart
Function of the four heart valves
Strength of the heart muscle

When cardiotoxicity occurs, we collaborate with our oncology colleagues to assess the risks and benefits of continuing your cancer therapy compared to the need to preserve your heart health. Our care teams provide therapies to treat and repair heart failure and other conditions.

After Cancer Treatment

Most forms of chemotherapy-induced cardiotoxicity appear within a year of treatment. However, the cardiotoxic effects of some cancer therapies can occur years after treatment is complete, which is called late cardiotoxicity. This is particularly true for radiation-induced cardiac injury, which has appeared as many as 20 years after exposure to chest radiation.

We identify those at highest risk for late cardiotoxicity. We monitor you in the years after cancer treatment so that we can implement preventive therapies if needed.

In general, the higher the cumulative dose of cardiotoxic chemotherapy or radiation therapy, the more likely cardiotoxicity will occur. This means that for some people receiving anticancer treatments that exceed certain threshold doses, doctors recommend cardiac monitoring for the rest of your life.