Heart failure from chemo (AC) anyone?

Hi GoldenGirls,

i don't know the answer, but didn't want your post to go without a reply, hopefully someone will know more than I do on this. Your mom is probably having an echo (ultrasound of the heart), but maybe an MRI, either way I think they'll be able to see what is going on. Heart failure on adriamycin is absolutely a known risk. Do you recall if she had a baseline echo before she started? I believe that is pretty standard, so hopefully they will be able to compare the before images with how her heart looks today after 5 rounds. Also, they often prescribe Doxil rather than adriamycin these days, exactly for the reason that it protects the heart. Doxil is basically the same drug, but with a liposomal coating (I think it is literally like one extra molecule or something), but that coating somehow keeps the chemo from attacking the cardiac muscle tissue. I learned about this because my stupid insurance company would not allow me to get dioxin, insisting that adriamycin had the same effectiveness for lower cost. My doctor tried to argue the point about heart safety, but we could not convince them, which was super frustrating. Anyway, all my rambling is to make the point that if Adriamycin has damaged her heart, it is possible they could switch her to Doxil.

Best wishes to your mom, hope she is doing okay.

Hello GoldenGirls. When I was originally diagnosed with early stage 9 years ago, a friend of mine in the young survivors community did develop heart failure from 4 rounds of AC for early stage disease. There is a lifetime maximum of adriamycin due to the heart risks. Your mom's doctor should have performed a MUGA scan (which might be what your mom calls the heart MRI) to test the heart's baseline capacity. My friend had to get a pacemaker and was on the list for a heart transplant but unfortunately passed away within a few years from heart failure. Of course, her case was extreme and is not common. She had "dose dense" AC, which is the full dose given every 2 weeks, so it was much stronger than your mom's dose. But your instincts are right on. Keep pursuing the issue with the doctor. There are other chemos out there to try. Also, Faslodex, a hormone therapy in a different class than Aromasin and the other aromatase inhibitors, is an option. There are also newer targeted therapy combos, such as Ibrance and Afinitor, which are given with one of the hormone therapies. Most doctors prescribe Ibrance with Femara or Faslodex and Afinitor with Aromasin but my doctor uses some of the hormone therapies interchangeably. I am currently on Ibrance with Aromasin and Faslodex. I hope she gets better.

I ended up with a problem with my heart after 6 years of chemo. My heart was racing and I did not even know it. They found out by a reg onc appt. I had to go in the hospital for 3 days. They gave me an injection to stop the rapid heart rate, but it only worked for 8 hours. I'm on medicine & checking regularly with a cardiologist now. Other than heart ablation, not sure what they can do.

Terri

Hi Michelle2013,

I just found out last week the chemo put me into the category of heart failure. My God, what is going on. I can't take much more. I attended some class today about all the drugs you can take but it all sounded very dreary and I had to walk out half way thru it. I wish I could connect with other women who are going thru this too. Once again I'm feeling alone in this and now hopeless ALL OVER AGAIN. I've been consumed with worrying about the cancer coming back and now I have to worry about my heart stopping!!

Thanks,

lexie2002

Any help from you or anyone out there would sure make a difference. HUGS

Artista928, Was your question for me? Sometimes I still don't navigate this board very well.

lexie2002

Lexie,

Do you know what your ejection fraction is?

Michele

I'm going to try and start a thread in the stage 3 forum.

Everyone that has issues with heart failure after chemo treatment look into Co-Q10 (ubiquinol). I have saw it first hand reverse heart failure from chemo treatments. Is natural, safe, and worth a shot.

I was dx'd with heart failure four years after 6 rounds of A/C. EF 10% in 2005, today 45%

Hello, my mother started her first chemo in Florida around December. Before that for a couple years they gave her pills. She then got asities and had to get her stomach drained weekly. I went to Florida in March and spent a week with her and she looked fine. I did notice one leg was noticeably swollen. I drove her back to Michigan on 3:16/16.?She had tests and the cancer had spread to her stomach. She had an echo cardiogram and the docs said they were going to start aggressive chemo, one was called adriamycin. I'll have to check in her journal for the other name. She had one dose of the new chemo on 4/13/16. On 4/15/16 she had a docs appt but wanted to go early cause she didn't feel good. They admitted her to get her streng back. Later that night they gave her medicine to drink for her nausea. They said she aspirated on it and passes away. My aunt was with her. The death certificate said the cause of death was cardiopulmonary failure or something like that, basically a heart attack. I'm blown away how fast my 71 year went from feeling fine to an unexpected death. I wouldn't want her to suffer but I anticipated more time and to get a call if it ever looked bad, before the end to be there. For the swollen leg they checked for a clot but that was negative, hope everyone in this situation has a better outcome

Hi, lexie2002,

It sounds like you are interested in hearing about women with heart issues from chemo. I've had BC x 3 (1996, 2006, 2009), with the last being mets to chest wall and skin. My treatment regimens have included radiation, chemo x 2 (first CMF/cyclophosphamide+methotrexate+5-FU, then TC/taxotere+cytoxan in 2009), and multiple hormonal therapies, including Arimidex, Faslodex, and Aromasin as well as Evista and Tamoxifen. My current status is NEAD, rather remarkable given that I stopped treatment in 2013, after recurrent neurological problems and several TIAs (including one resulting in permanent moderate hearing loss in my left ear) attributed to hormonal therapies. I started experiencing symptoms of angina as early as 2010 but was NOT diagnosed with heart disease until January 2015. Even when I specifically asked my oncologist and PCP about heart disease--and requested a referral to cardiology--my concerns about my heart health were dismissed or minimized. (Many of my symptoms were attributed to vague late effects of radiation, chemo, and/or hormonal therapies.) I eventually experienced an episode of unstable angina/Acute Coronary Syndrome, which landed me in my local ED, where I was finally given a referral to cardiology. My cardiologist advised me that he has seen quite a number of women with various types of heart disease following (and during) treatment for breast cancer, often after a major event following little attention being paid to cardiac symptoms and risk factors related to breast cancer treatment. Now I have multiple cardiac diagnoses, including Vasospastic Angina/Coronary Artery Spasms, Coronary Microvascular Dysfunction, Tachycardia, three leaky heart valves, and Moderate Diastolic (Left Ventricular) Dysfunction, which creates intermittent episodes of HFpEF--Heart Failure with preserved (or normal) Ejection Fraction.

In the last couple of years, more information about the risks of cardiac disease for those of us who have experienced or continue to undergo breast cancer treatment have been brought to light. For those who are interested, a scientific statement from the AHA was published just last year and included this statement: "Cancer treatment can result in early or delayed cardiotoxicity that can vary from LV dysfunction to overt HF, hypertension, arrhythmias, myocardial ischemia, valvular disease, thromboembolic disease, pulmonary hypertension, and pericarditis. The most commonly reported and monitored side effect of chemotherapy is LV systolic dysfunction.^… Arrhythmias, independent of other concurrent cardiac disease, can occur from breast cancer treatment, including chemotherapy and radiation therapy (RT)…. Several chemotherapeutic agents can also prolong QT intervals....The absence of a clear consensus in definitions of cardiotoxicity makes it difficult to compare results of cardiac end points between clinical trials and furthermore makes the applicability of these findings in the real world challenging at best. This section will briefly review the pathophysiological mechanisms and resultant adverse cardiovascular effects of common therapies for breast cancer (Table 1. Cancer Treatment and Cardiovascular Adverse Effects)." This paper then discusses various therapies and risk factors, monitoring for cardiovascular toxicity, strategies to mitigate cardiotoxicity, and other issues, such a cardiovascular surveillance strategies. Although this paper seems to be directed toward those who have been designated "survivors," the information applies to all women who have undergone breast cancer treatments. (This paper can be found at https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000556#.XL23PGL26z4 )

Lexie2002, if you don't feel comfortable continuing this conversation here, please feel free to send me a PM if you would like to discuss concerns about heart issues related to treatment. I've experienced quite a few years dealing with significant heart problems, and I am always willing to connect with women who are concerned about or experience similar problems.

Hi, Lexie! Yes, I was diagnosed with Left Ventricle systolic Heart Failure this March of 2019! I had 8 rounds of chemo, 4 AC and 4 taxotere, 37 radiation treatments in 2004-2005! I also took Aromasin for 11 years!! My cardiologist definitely suspects my treatments caused the Heart Failure! I am taking two amazing medications! One is Entresto, a relatively new drug!! It has been a miracle drug for me! My shortness of breath has become so much better! My original EF was 25% and hoping that my next Echo shows improvement! My cardiologist is happy with my improvement! There are also new meds on the horizon! I am almost 15 years out from Breast Cancer and hoping the same or more with Heart Failure🤗🤗🤗