Diastolic Dysfunction From Herceptin?

her2intn

I completed 12 weekly doses of taxol/herceptin Feb 23rd, and just had my 3 month echo before starting every 3 week herceptin for the remainder of a year.  My echo shows mild atrial enlargement and stage 1 diastolic dysfunction.  I will be seeing a cardiologist who actually has heard of herceptin and has started some studies on it.  I am reading more and more people in the forums stating they are seeing this on their echos while taking herceptin.  3 months ago my echo was perfect!

I would like to hear about others who were told they have these findings on their echo while taking herceptin please..  Since I just completed chemo, I don't know which is the culprit.   No, I don't want breast cancer, but I also don't want to ruin my heart either, if there are these changes after 3 months, and I am about to triple the dose for every 3 weeks, what will my echo be like in 3 more months?...My ejection fraction was fine ar 60%.  Please respond if you have had a similar experience..

anonymice

I will tell you that they don't *know* what herceptin can do to your heart, or anything else long-term (and sometimes short term), because it just the best drug that has come along ever really and they stopped long term trials so we Her2+ ladies can stop facing quick recurrences and death.

A woman might be trading off a death from cardiac complications but a) they can do so much with the heart, it is understood so much better and is not a fraction of the complication that cancer is...

and b)  Her2+ cancer is a known, aggressive, quick killer....until of course, Herceptin and the other related drugs that are being used currently/soon. 

Obviously every case should be monitored individually for risk vs benefit, but if you can *take* herceptin, you already have an aggressive cancer.  It is very complicated and I do feel for you, and with my own heart scan coming up I will be very curious to see the result.

I have several times heard of women resting from Herceptin, needing to take some cardiac drugs for a few months, and then continuing on to get their year of treatment in.  Perhaps that might be an option for you.

Is it possible that stress could have had that effect on your heart?  Goodness knows we're under that.... 

Omaz

Hi Her2intn, My understanding is that the echo is an estimate of heart function.  For example my pre-chemo echo EF was 73% and when I finished chemo it was estimated at 55-60%  That seemed like a big drop to me but my onc was not concerned because it was felt that my first estimate was probably too high.  My last echo was 60%.  If you are worried you could ask them to do a MUGA.  If my onc suspects problems from the ECHO he orders a MUGA.  Also, I think the interpretation of the ECHO is somewhat subjective and you may have had two different doctors evaluate your two ECHOs.  Good luck!

Marybetz

My heart function went down to 30%, however since I'd only had three infusions of Herceptin my cardiologist felt that it was probably due to the A/C chemo, which can also do damage.  Know one knows for sure.  I've been on two meds for five months (lisiniprol and cardevoil) and my EF is slowly climbing back up.  Is now at 45%.  Dr.'s told me that it must be at least 50% to go back on Herceptin.  Meanwhile only on Femara. 

Omaz

Her2intn - You got me to thinking and I went back to my results from the earlier echos and on the one after chemo it says 'grade 1 diastolic dysfunction' and it wasn't there on the previous echo before chemo.  So I guess I am in a similar boat with you!

blondie45

I had 6 months of herceptin and then it was found on echo that my ejection fraction was down to 25 to 30%. I had an echo 3 months prior to this being found and my ejection fraction was in the normal range above 50%. I went on 2 heart meds and still am on them almost 1-1/2 years later. Together, my onc, cardiac doctor, and I decided that I had enough herceptin having had it for 6 months. I really let my onc and cardiac doc make the decision about going back on after having had the 6 months or 17 treatments of herceptin. I have a close friend who had a lowered ejection fraction much sooner into the herceptin treatments than 6 months and she had the herceptin stopped for a little while, went back on, the ejection fraction was down again, went back on again and has now finished her treatment of herceptin. It is definitely possible to stop the herceptin for a little bit and then go back on.

truthpharma

You are wise to keep track of your echo reports!  However, your post does raise a question in my mind.  Did the same radiologist/specialist who interpreted your most recent echo interpret your original echo?  I ask this because I recently had an abdominal CT scan and the radiologist who did the original read stated that I had an enlarged liver.  After having my CT scan viewed by another radiologist, he indicated my liver was not enlarged, but had an additional lobe (Riedel's lobe).  I suggest you go to the facility that did you original baseline echo and tell them you need a copy on CD.  Take your original echo and most recent echo CD's to the cardiologist and ask the cardiologist to compare them to verify the changes in your atrial size and diastolic function.  However, the cardiologist will probably not be able to give as accurate a risk/benefit ratio on Herceptin therapy as your oncologist can.  Finally, since you are concerned about receiving a higher (3 week) dose of Herceptin, have you considered continuing weekly dosing through the remainder of your therapy?  Good luck to you and God bless!

Omaz

I did not have any diastolic dysfunction mentioned on my first pre-chemo echo but the last two have both noted a 'Grade 1 diastolic dysfunction'.  All were read by different physicians.  What does a grade 1 dysfunction mean?

Scrabblelady

This is the best description of  Grade 1 diastolic dysfunction.  It was written by a cardiology nurse.  Hope it helps.  Sorry that it's a bit long.

The heart pumping takes just about a second to complete in two steps. The blood is collected in the right and left atria and a signal is sent out by the sinoatrial (SA) node. This electric signal makes the atria contract and pushes the blood through the tricuspid and mitral valve.
The blood now enters the right and left ventricles and the heart now relaxes. 

This relaxing phase is called the DIASTOLE. Thus, completing the first step of the pumping action of the heart. 

When the SA node sends an electric signal to the ventricles full of blood, they contract. This contraction of ventricles is called as the systole. The back flow of blood is prevented as the tricuspid and mitral valve close. 
The pulmonary and aortic valves are opened and the blood is pushed into the right ventricle into the lungs.
Then the oxygen rich blood flows into the left ventricle and from here it is pumped to the circulatory system of the body. 

When the heart fails to relax or suffers from impaired relaxation action, it leads to an abnormal pumping cycle. This is called as the DIASTOLIC DYSFUNCTION. 
The ventricle fails to relax normally and thus the pressure increases causing problems in the next heartbeat

And as the heart doesn't recover it will happen again in the next cycle.

GRADE 1 DIASTOLIC DYSFUNCTION
The grade 1 diastolic dysfunction is a mild condition that can also be termed as the early stage of diastolic dysfunction. There are no clinical signs of grade 1 diastolic dysfunction symptoms in many patients

As such it often goes undetected until it reaches a higher grade. 

Omaz

Thanks Scrabblelady!

Kay_G

I just finished AC two weeks ago.  Started Herceptin and Taxol on Monday.  Had an echo before starting AC and after finishing.  Also had the Diastolic disfunction show up on the second echo.  My doc says it is nothing to be concerned with.  Apparently if you get high blood pressure which I currently don't have, it could get worse, but for now nothing to worry about.  I would rather not have it at all, but I think PAMIN WV is right.  You have to take the lesser of two evils.  The cancer is much more dangerous at this point, so I am going with what the doc tells me.  Good luck.

cherokee807

Did any of you have any symptoms? I have been short of breath badly!!!!! More tired than normal etc. I had my first Echo in Feb. 2011 before I started every 21 day AC. Then in May when I was done & before starting Taxol I had another Echo done. Received 1 or 2 more treatments of Avastin with Taxol and then my Onc stopped Avastan cause of Echo reading. I keep copies of bloodwork etc but don't have echo reading. Went for follow-up July 1 so will be interesting to see what this one shows. I know I signed papers before Avastin for the damage it can cause but was hoping it wouldn't happen..........Have to agree with a few others who replied........WE have to kill this freakin cancer we are dealing with first..........then we will pray that for all of us who have had other damages caused that those will be an easy fix........ GOD Bless all of you........let's keep Fighting the Battle........ WE will WIN this War........... </p>

kathleen1966

My ejection fraction went down to 45 seven months into Herceptin (started at 55, which is low normal).  My Herceptin was never cancelled.  I recently had another echo and it is back up to 55 without having stopped Herceptin. I was told it can be the test, where you have the test and that this is what the heart sometimes does when it's on Herceptin.  Most importantly, these heart changes go back to normal afterwards (with Herceptin, not with AC chemo).  The AC (or is it A) chemo can do heart damage that is not reversible and most oncologists are no longer using it for this reason if you are her2+ and need Herceptin.

rmorales8860

I was 4 months into chemo finished taxol and herceptin and I just finished my FEC 2nd round when my heart to a downward turn.  When I started my treatment my EF was at 60%.  After the 2nd round of FEC it went down to 30%.  I went on a Chemo vacation from April 28, 2011 to July 28th and that is when I started herceptin again because my heart went back up to 55%.  I am taking my 2nd dose tomorrow and I will have my echo ran again next week.  During my vacation I took coredevial (sp) and lisonpryl.  There is hope! My Onc told me that we will continue until it drops again and then I will go on vacation again.  This might be a long process but I need that drug and I am willing to do anything for it.

Grimbol

I haven't read this thread before but I am very relieved to hear all of this actually.  My EF was at 55% before tx started, (I've only had one so far) and that really concerned me.  I don't understand these things at all but 55% seemed horrible, so to read this has helped me calm down about it, thank you.

Lindalulu_2222

I am late in my reply to these ladies but maybe a new person will get some use of my post. I had 4 herceptin treatments and it gave me an enlarged heart, a blood clot in my heart and congestive heart failure. The worst part is that I got a second opinion on my cancer diagnosis and 2 other pathologists found that I did not even need herceptin in the first place. PLEASE ladies get second opinions on everything and ask a lot of questions. I trusted my doctors and the hospital and now my life has changed forever because of a  mistake that a pathologist made. I can't work or do many of the things that I used to be able to do and will be on medications for my heart the rest of my life, not to mention all of the medical bills that should have never been. Please be careful ladies. I was having Muga scans too but in between them my heart totally failed and it tested at 59 before the herceptin treatments and fell to 15%. I almost died. Hope this helps someone out there.