Dr Amresh Raina: Cancer Treatments Are Affecting Heart Function in Many Ways

Amresh Raina, MD, director of the Advanced Heart Failure and Pulmonary Hypertension Program at Allegheny General Hospital and the Allegheny Health Network in Pittsburgh, Pennsylvania, is a board-certified advanced heart failure cardiologist, who is also certified in echocardiography and general cardiology.

Transcript

Can you discuss some of the top issues relating to cardiac care that result from cancer treatment?

The fact that cancer care has really evolved and that there are a lot more chemotherapeutic agents and patients live longer has led to the development of an entire field, what we call cardio-oncology. And the reason that that’s relevant is many of the cancer treatments can impact the heart or the pulmonary vasculature in one way or another. For example, some of the chemotherapeutic agents for breast cancer can make left-sided heart function become abnormal. Frequently these patients are monitored with serial cardiac imaging, whether it’s echocardiograms, MUGA [multigated acquisition] scans, or cardiac MRIs to ensure that there’s no evidence of cardiac toxicity from those medications.

And if there is evidence of cardiac toxicity, there’s a variety of different things that we can do to get patients through their chemotherapy, but also to try to help their heart function recover, whether it be medications or temporary interruptions of the chemo while switching to other agents. We see a lot more patients in the cardiac arena who have impact of cancer chemotherapy on their heart function.

Another sort of related issue to that is, in the world of pulmonary hypertension, we are seeing more and more patients who have pulmonary hypertension that’s related to some specific cancer chemotherapeutic agents. There is a class of agents called tyrosine kinase inhibitors, which are increasingly used for a number of different cancers, and these can be associated with the development of pulmonary arterial hypertension, or PAH. This has been increasingly recognized, and so if one is not looking for it, one might not be aware that this is a physiology that can occur in a small subset of cancer patients.

The other thing that I will mention about cancer is [that] cancer is a prothrombotic state and many of the patients who have cancer, whether it’s active or even in remission, can be at risk for developing blood clots, what we call deep venous thrombosis, blood clots in the legs, or even blood clots in the lungs, what we call pulmonary embolism. That’s something that we obviously can treat aggressively, not just with blood thinners, but sometimes with mechanical thrombectomy or clot-busting agents, when people are very symptomatic with blood clots.

Lastly, in patients with cancer who require radiation, radiation therapy can be associated with the development of cardiovascular complications. It can cause coronary artery disease due to constriction of the blood vessels in the coronary arteries that supply the heart, but it can also affect the heart and the heart valves, causing calcium deposition in the heart valves and causing narrowing and leakiness of the heart valves, but also stiffness of the heart and the heart muscle and can lead to later on congestive heart failure down the road.

So we see a lot of potential impacts of cancer and cancer therapies on the heart and the heart function.