Echocardiogram shows range of 55

Several things - first is that echocardiograms are, to a degree, subjective. The percentage for your ejection fraction could be 55 with one tech, and 57 with another based on that same exam. 50-70 is considered a normal measurement of LVEF. 54 is not low, and often people receiving Herceptin start at that number. Under 40 is considered CHF, and a measurement between 40-50 is a gray zone - could be a problem, but not necessarily - this would warrant careful monitoring. Generally, when Herceptin is combined with an anthracycline, like Adriamycin, cardiac issues are likely to be more permanent. This is one of the reasons many oncologists like to eliminate the anthracycline and use taxane based chemo with Herceptin, as most often drops in LVEF are reversed when Herceptin is discontinued, or the course of treatment is finished. Taxane based regimens are favored by Dr. Dennis Slamon for this reason, he is the researcher at UCLA who brought Herceptin to the market. It is common to see small drops in LVEF during the year of Herceptin infusion, as long as there is not a large percentage drop in a quarter, most oncologists stay the course. This is what happened to me, my LVEF dropped a point or two each quarter, down to low 50's, but my LVEF recovered to 60-ish when I was done with Herceptin.

Actually, SpecialK said it all. I just want to confirm. Heart problems due to Herceptin are considered reversible - not so much those caused by an anthracycline. When I started chemo treatment last month, my onc considered to change regimen to TCHP instead of doing dose dense AC first. That was due to my 1 year old echo that showed LVEF at about 53. NOTE: He would have gone with TCHP nevertheless. However, a new echo had my LVEF at 63. Thus, I could start with the AC infusions. Frankly, before I had the new echo, I was pleading with my onc to throw at me whatever it takes to fight the cancer - my heart will manage somehow. I guess that reflects the difference of priorities with regard to stages. If I was stage 1, I'd most likely be also more concerned about heart issues and tried to avoid any risks. But from everything I've read so far, you really don't have to worry at this point.

The official recommendation for herceptin and perjeta are (I only have the document in German, so I quote the essentials here):

Treatment shall be interrupted if one of the following occurs:

1) LVEF drops to under 40%

OR

2) LVEF drops to 40-45% AND this drop is >10% of the initial individual baseline

So being at 55 still puts you in a quite comfortable position, and the regular monitoring will prevent to get you near CHF.

Denise - just to make sure... Was your heart regularly monitored? Because LVEF didn't drop from 65 to 29 all of a sudden, I take it.

Also, I see that you also had AC. Are your doctors sure that it wasn't that causing the permanent damage, which then became obvious and was getting worse with herceptin on top of it? Just asking bc you write your LVEF was 65 before chemo, not necessarily before Herceptin.

But most importantly: Congratulations on your 5.5 years out. That is so great !!!

Saying ditto to those who have explained that damage from Adriamycin is usually permanent. Damage from Herceptin is usually reversible. My MO was very careful to stop the Herceptin for the period I was taking Herceptin. He also ordered an Echo every 6 weeks to 3 months depending on where I was in treatment.

Enia - I had AC chemo first - had heart damage from AC..  I had ALOT of echos - I lost count I had so many.  But before I started

Herceptin, LVEF was still in "normal" range - I believe like 55.  When I got to the third month of Herceptin and Taxol,

that is when it went to 29 and the permanent valve damage occurred.   I went to a cardiologist (and still go to him)

that specializes in cancer patients. My heart never improved to restart Herceptin.

Thanks for your kind words about my 5.5 years!

If I recall correctly, it is unlikely that problems will show up later that do not present themselves now but yes, you should see a cardiologist. I'm assigned to follow up with one every 3rd echo or if the need arises. If heart issues become significant, there are options. I know taking a break from Herceptin is one or beta blockers to protect your heart is another.

I had problems with Herceptin and my oncologist stopped it permanently after 8 treatments. I had 6 with taxotere and carboplatin. I had 2 more Herceptin only. My LVEF started at 53 (low normal)and eventually dropped to 40. I was on hold for a few months. In the meantime I saw a cardiologist and went on blood pressure meds and an ace inhibitor. My LVEF eventually went back to 50, but my oncologist said she didn't want to risk permanent damage so Herceptin was stopped. I am 61 and was overweight and inactive prior to being diagnosed. I did lose 40 pounds during chemo due to appetite and taste issues and now am more active. I saw my cardiologist this week and he is doing another echo in September and will follow up with an MRI if I am not back to normal to determine how my heart was effected. I hate the fact that I couldn't finish the year of Herceptin.

I have considered and you might try a consult with cardio/oncology department at Cleveland Clinic.

Most docs do ECHO tests or MUGA test sporadically during the treatment times. See if you can get your MO to order that.

I also had to stop herceptin due to heart issues. When I began taxol/herceptin for 12 weeks my ejection fraction was 56. I stopped the taxol at week 10 due to side effects. They hydrated me for 2 weeks, then did the final 2 weeks of herceptin. At that time my ef dropped to 45-46. It did rebound so they began the every 3 weeks herceptin regime. After 6 of these treatments my ef had dropped to 41. Doctor called off all herceptin treatments for fear of heart damage. Another MUGA scan after 4 months showed no improvement, in fact some reduction. Now the oncologist tells me damage isn't always reversible in older women. I am 70. I have switched oncologists because of many miscommunications. New dr agrees with treatments I received and with stopping. Frustration doesn't begin to describe it.