Although necessary, some treatments for lymphoma can cause side-effects that may affect your heart. Heart disease is a broad term to describe many different conditions affecting the heart. In some cases, heart disease may be temporary but some will last the rest of your life. You may need to see another doctor (Cardiologist) who specialises in managing heart disease.
Having radiation therapy to an area close to your heart, some chemotherapy, some monoclonal antibodies and some targeted therapies can all cause heart disease to develop.
What treatments can cause heart disease?
The types of changes you may experience will depend on the type of treatment you had. Click on the headings below to learn about the types of changes that can happen.
Radiation treatment to an area in the middle, or to the left side of your chest can affect your heart. New techniques with radiation therapy can reduce the amount of radiation that gets to your heart, but they may not eliminate the risk altogether.Â
Effects to your heart can happen within weeks or months of having treatment, however the risk of heart changes increases with time. You may not have any symptoms of heart disease for many years after finishing radiation therapy.
The damage to your heart may cause inflammation and scarring to the:
- thin membrane that lines the outside of your heart to prevent friction as your heart beats (pericarditis).
- your heart muscle (myocarditis).
- inner structures of your heart such as deep muscle and valves that keep blood flowing in the right direction (endocarditis).
- lining of your heart chambers (endocarditis).
Not all chemotherapy will affect your heart. However, there are certain chemotherapies that are common in treatment protocols that have the potential to cause heart disease. You are more likely to have have heart disease as a side-effect if you have existing risk factors such as diabetes, high blood pressure, or you are also having radiotherapy to your chest.Â
- daunorubicinÂ
- doxorubicinÂ
- epirubicinÂ
- idarubicinÂ
- mitoxantroneÂ
- cisplatin
- cyclophosphamide
- ifosphamide.
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Immune checkpoint inhibitors are a type of monoclonal antibody that work by blocking proteins on your lymphoma cells. These proteins make the lymphoma look normal to your immune system so your immune system lets them continue growing. By blocking the proteins, your immune system can recognise the lymphoma as a cancer and fight and eliminate it.
Unfortunately, these same proteins are found on your normal cells – including the cells of your heart. So when these proteins are blocked on your heart, your own immune system can start to attack your heart causing inflammation and scarring.
Immune checkpoints that may cause side-effects affecting your heart include:
- nivolumab
- pembrolizumab
- durvalumab
- avelumab
- atezolizumab
- ipilimumab.
Some targeted therapies can cause arrythmias. Arrythmias are changes to the rhythm of your heart beat. This may include a faster or slower heart beat than usual, and sometimes it is an irregular heartbeat.Â
Most of the time these arrythmias can go unnoticed and not have any harmful effect. However, occasionally they may be more serious and very rarely they can be life-threatening. Serous complications are more common with people who have existing heart disease (including high blood pressure, or arrhythmias), or illnesses such as diabetes.Â
Report all changes in your heartbeat to your doctor. They may need to change your dose of medicine, or start you on a different medicine to help your heart beat more regularly.
Symptoms of heart disease
In the early stages of heart disease you may not have any symptoms. However, common symptoms can include:
- difficulty breathing or shortness of breath
- chest pain
- changes to your heart rate or feeling your heartbeat more than usual (palpitations)
- changes to your blood pressure
- dizziness or feeling lightheaded or faint
- swelling in your arms or legs
- extreme tiredness (fatigue).
When to contact your doctor
Make sure you report any of the above symptoms to your haematologist or nurse as soon as possible. If you do not have an appointment with your haematologist or oncologist in the next 2 or 3 days after these symptoms start, see your local doctor (GP) as soon as possible.
Report any new changes to your doctor, even if you finished treatment months, or years ago. Let them know you had treatment for lymphoma in the past, that may increase your risk of heart disease.
* Severe shortness of breath
* Chest pain or pressure in your chest
Management
The management of heart disease will depend on the type of treatment you have had for your lymphoma, and the type of heart disease you have.
There are many different types of heart disease. In some cases you may simply need a smaller dose of the medicine causing problems. Your doctor may also choose to remove or swap a medicine for one less likely to cause damage to your heart.
In certain circumstances you may need to be referred to Cardiologist, a doctor who has expertise in heart conditions. They will then be able to assess and manage your heart disease.
Some treatments for heart disease may include:Â
- heart medicines to improve and stabilise your blood pressure or heart rate.
- fluid restrictions so your heart does not need to process as much.Â
- diuretics, which are medicines to help you wee (urinate) more to get rid of extra fluid.
Summary
- Heart disease is a name to describe a group of different conditions that can affect your heart.
- Many different types of treatment for lymphoma can result in heart disease, most may be temporary, but others may need lifelong treatment.
- You are at higher risk of getting heart disease as side-effect of treatment if you already have a heart condition or other illnesses such as high blood pressure or diabetes.
- Heart disease may start soon after your treatment, or years after treatment finishes.
- Treatment for heart disease will depend on the type of heart disease you have and your overall health.
- Report all symptoms of heart disease to your doctor as soon as possible, even if your finished treatment years ago.
- Call an ambulance on 000 (Australia) if you have chest pain or severe shortness of breath.
