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Cardiac (Heart) Late Effects

Cardiac late effects in childhood cancer survivors occur due to certain treatments. Anthracycline medicines and chest radiation may lead to heart disease in some childhood cancer survivors. In this image, a physician listens to a childhood cancer survivor’s heart during a check-up.

Cardiac late effects in childhood cancer survivors occur due to certain treatments.

What are cardiac late effects?

Some childhood cancer treatments may cause heart problems after treatment ends. These are called cardiac late effects. Cardiac means "related to the heart."

Radiation to the chest and a type of chemotherapy called anthracyclines are the main causes of cardiac late effects.

Most childhood cancer survivors do not have heart problems due to cancer treatment.

Healthy habits such as physical activity and a heart-healthy diet can help you manage or prevent many heart conditions. 

A graphic of an anatomical heart, colored red and blue, with labels for the aorta, superior vena cava, right atrium, tricuspid valve, pulmonary valve, right ventricle, septum, left ventricle, aortic valve, mitral valve, left atrium, pulmonary vein, and pulmonary artery.

The heart is a muscular organ that pumps blood to the body’s organs. The heart is at the center of the circulatory system, which is made up of a network of blood vessels, such as arteries, veins, and capillaries.

Learn how the heart works

  • The heart is a muscular organ that pumps blood to the body’s organs. 
  • It is at the center of the circulatory system, which is made up of a network of blood vessels, such as arteries, veins, and capillaries.
  • An electrical system controls the heart and uses electrical signals to contract the heart's walls. When the walls contract, the heart pumps blood.
  • Valves in the heart chambers keep the blood flowing in the correct direction.
  • A healthy heart supplies the body with the right amount of blood at the rate needed to work well. If disease or injury weakens the heart, the organs won't get enough blood to work correctly.

Cardiac late effects that may occur

Cardiac conditions that may occur include:

  • Coronary artery disease
  • Abnormal heart rhythms (arrhythmia)
  • Scarred or leaky heart valves (valvular stenosis or insufficiency)
  • Inflammation and scarring of the membrane surrounding the heart (pericarditis or pericardial fibrosis)
  • Heart muscle weakening (cardiomyopathy)

Cardiomyopathy can get worse over time. It can lead to heart failure.

Causes of cardiac late effects

Anthracyclines

Anthracyclines are medicines used to treat many types of cancer.

These medicines include:

Anthracyclines can damage the heart muscle (cardiomyopathy). This damage can include heart failure. The risk of developing this condition increases with the amount of medicine given (dosage).

Anthracycline dosage (cumulative)
Risk of heart failure
Less than 100 mg/m2
Low
More than 250 mg/m2
Moderate
250 mg/m2 or greater High

Chest radiation

Radiation given near the heart is a risk factor for heart disease. The risk increases with the amount of chest radiation given (dosage).

Radiation dosage
Risk
<15 Gy
Low
15 Gy–<30 Gy
Moderate
30 Gy or more High

Anthracyclines and chest radiation

Survivors who had both anthracyclines and chest radiation have the highest risk.

Other risk factors for cardiac late effects

  • Family history of heart disease
  • Other health problems:
    • Obesity
    • High blood pressure
    • High cholesterol or triglyceride levels in the blood
    • Diabetes

Diagnosis of cardiac late effects

At first, survivors may not have symptoms. But heart disease may be present.

An echocardiogram (echo) is an easy, non-invasive way to detect heart disease before symptoms develop. It uses sound waves to make images of the heart.
 

A female nurse performs echocardiogram on small male child in hospital room

Heart tests such as an echocardiogram (echo) detect early signs of heart disease.

Symptoms of heart disease

Patients may have:

  • Coughing and wheezing that does not go away
  • Heart racing or throbbing
  • Irregular heartbeat
  • Chest pain
  • Shortness of breath
  • Swollen feet and ankles
  • Dizziness and feeling lightheaded
  • Fainting
  • Severe fatigue
  • Sweating
  • Nausea

What you can do about cardiac late effects

Cancer survivors can do things to promote heart health:

  • Know your risk of developing heart problems. Ask your doctor if your treatments may increase your risk for heart disease.
  • Share a copy of your survivorship care plan with your health care providers.
  • Have regular check-ups.
  • Have echocardiograms and other screenings as recommended in your survivorship care plan. Guidelines depend on the treatment you received.
  • Talk to a cardiologist (heart doctor) if there are signs of damage to the heart.
  • Get treatment for conditions that affect heart health.
  • Have good health habits.

Heart-healthy habits

Habits that promote heart health include:

Questions to ask about cardiac late effects

  • What is my risk of having heart problems?
  • Does the treatment I received put me at higher risk for heart problems?
  • Do I need an echocardiogram?
  • Am I at risk of other complications from childhood cancer treatment?
  • What can I do to lessen my risk of heart problems?
  • What can I do to lower my anxiety about having heart problems?

Key points about cardiac late effects

  • Some childhood cancer treatments may cause heart and blood vessel problems after treatment ends. These are called cardiac late effects.
  • Chest radiation and chemotherapy with anthracyclines are the main causes of cardiac late effects.
  • It is important to know your risk for developing heart problems, so that you get screening and/or recognize symptoms early.
  • There are ways to manage many conditions.
  • Heart-healthy habits (such as regular exercise, good nutrition, not smoking, keeping a healthy weight) can help prevent cardiac late effects.



The Together by St. Jude™️ online resource does not endorse any branded product mentioned in this article.


Reviewed: October 2023