What is Cardio-Oncology?
Cardio-oncology is a new medical discipline focused on optimally treating any associated heart conditions in patients who have been treated for cancer, or are currently being treated for cancer. Specialized cardiologists can assess patients for the potential risk of developing certain heart conditions, especially if they are receiving particular types of cancer drugs, or following radiation treatment to the chest. A group of specialized cardiologists, cardio-oncologists, have particular expertise in preventing and treating harmful effects of the heart from cancer and cancer therapy, and can provide consultation in diagnostic testing, medical management, and interventional and surgical procedures. The Washington University Cardio-Oncology Center works closely with the Siteman Cancer Center to facilitate cancer therapy and limit any potential associated cardiac toxicities with the ultimate goal of improving the survival and quality of life of our patients with cancer.
Risk Factors and Cardiotoxicity
The survival of patients with cancer has dramatically improved over the past 30 years with the introduction of new, effective cancer therapies. As a result, there is an impressive increase in the number of cancer survivors. A growing array of complex new therapies allow for even better overall outcomes for patients being treated for cancer. However, these therapies do have toxicities, especially on the cardiovascular system. The good news is that providers are becoming increasingly aware of potential cardiac toxicities from various cancer treatments including arrhythmias, valvular heart disease, coronary artery disease, hypertension and heart failure.
What conditions are associated with Cardio-Oncology?
Many symptoms experienced during cancer treatments may also be associated with a decrease in heart function. Sometimes a decrease in heart function will have no particular revealing symptoms. This is why it is important to have a heart specialist monitoring your tests early on in the treatment. It is possible that some of your symptoms may be associated to a reduction in heart function. Fatigue, shortness of breath while walking or even at rest, waking up short of breath from sleeping, swelling in your legs and/or chest discomfort (dull, or sharp pain, tightness or pressure) are all possible indications of a developing heart problem.
Diagnostic Cardiac Tests
In order to monitor your heart and determine the need for cardio-oncology treatment, there are several tests that may be evaluated while you are receiving cancer treatment. The echocardiogram is an ultrasound of the heart. Measurements are performed on the images, and with each heart beat an estimated volume of blood pumped out of the heart can be calculated. This estimated percentage is called the left ventricular ejection fraction (LVEF). It is known that many anti-cancer medications can potentially reduce the LVEF. Your oncologist may perform an echocardiogram at the beginning of your treatment and periodically during and after your treatment. If there is more than a 10% decrease in the volume percentage, you will likely be referred to a cardio-oncology provider to determine if any medications could be helpful to protect your heart. Other tests, including simple blood tests or imaging, may also be performed during your routine lab work and testing. Common lab tests and cardiac imaging:
- BNP, NT-proBNP
- Troponin I or T
- Lipid Profile
- Electrocardiography (EKG)
- Echocardiography (Echo)
- Cardiac MRI
Your cardio-oncologist will monitor the results of these lab and imaging tests. If any results show a change in heart function, you may need to start taking routine medications that are used for cardio-protection. Often times, once the cancer therapy is completed, the heart function may improve. Therefore, your cardio-oncologist will monitor your test results even after you are treated and ultimately, it may then be possible to reduce the dose of the heart medications or stop them completely. There are new technologies being developed in cardiac imaging, called strain imaging, that may be helpful in the future. Cardio-Protective Medications Used with Cancer Therapy
- Certain beta blockers, like carvedilol, can improve the heart rate control and decrease the resistance the heart has to beat against, thus helping to preserve the muscle function of the heart. These are typically used in the general population for high blood pressure or congestive heart failure. There have been recent research studies that show this medication may prevent irreversible cardiac dysfunction associated with some anti-cancer medications. Examples of these medications are carvedilol (Coreg) or nebivolol (Bystolic).
- ACE inhibitors are another class of medications that have also been shown to protect the heart during anti-cancer medication therapy. Examples include Lisinopril or Enalapril.
- Spironolactone may be used if the LVEF (left ventricular ejection fraction) of the heart is reduced and you start to have increased swelling in your legs or abdomen and increased shortness of breath.
- Learn more about LVEF and cardiac dysfunction
Where is care provided?
Our cardio-oncology team sees patients in the Center for Advanced Medicine and at Barnes-Jewish Hospital. You can request an appointment here.