By Geoffrey Zarrella, DO, FACC, and Jerome Horwitz, DO—Virtua Cardiology

Cancer is the second-leading cause of death in the United States, right behind heart disease. While new therapies are helping more people survive cancer, they also can cause heart problems.

Cardio-oncology combines the expertise of cardiologists and oncologists to help protect the hearts of people undergoing cancer treatment.

Cancer treatment can be a double-edged sword

Chemotherapy is a drug treatment that uses powerful chemicals to kill fast-growing cancer cells in the body. However, these same chemicals—such as anthracyclines, mitoxantrone, paclitaxel, and cyclophosphamide—also cause cardiac toxicity, leading to damage of the heart muscle and valves.

These drugs can cause an enlarged heart or swelling of the heart or the sac around it, which can lead to heart rhythm problems (arrhythmias) and heart failure. They also can cause blood vessel damage, reducing blood flow to the heart and raising the risk of a heart attack.

In addition, chemotherapy drugs can interfere with blood thinners people take to prevent clots and lower their heart attack and stroke risk.

It’s important to note, however, that newer, targeted therapies like Herceptin are thought to cause only temporary heart damage.

Here to protect your heart

Working with oncologists, we identify people who are about to have chemotherapy or who are undergoing treatment. We then evaluate them for heart problems, such as congestive heart failure or left ventricular dysfunction.

To evaluate patients, we use a screening test called three-dimensional echocardiography with global longitudinal strain.

Strain describes the elastic properties of the heart muscle. If the test shows reduced strain, this signals earlier cardiac dysfunction that can eventually lead to heart failure and chemotherapy-related cardiomyopathy (a condition that makes it harder for the heart to deliver blood to the body).

By looking at strain, we can see who’s at risk going into chemotherapy. If you’re already undergoing treatment, we can determine if you're already experiencing damage.

To prevent damage and protect your heart, you may be prescribed medication such as:

• Beta blockers
• ACE inhibitors
• Angiotensin receptor blockers

Keep your heart in mind during cancer treatment

If you have cancer, talk with your doctor about the benefits and risks of potential treatments. Together, you can discuss how they might affect your heart health so you can determine your best options.

To make an appointment with a Virtua cardiologist, call 888-847-8823.