cardiotoxicity and cardiomyopathy
At the very beginning of my treatments last year I had an echocardiogram to have a baseline of my heart function. Some chemo and targeted therapies can cause weakening of the heart, also known as cardiotoxicity, so we needed to ensure I was starting off strong. Which, I was! My heart was in perfect working condition.
Cardiotoxicity is a term for any heart damage arising from cancer treatments. It's more common in people who have used specific chemotherapy or targeted therapy drugs.
We continued the echocardiograms quarterly throughout my treatment with the Red Devil (adriamycin) as it can cause cardiotoxicity. Through those echoes we found I was staying strong so we didn’t continue. Then when I started Herceptin, my oncologist reinstated the quarterly echo-cardiograms and Herceptin, in rare cases, can cause cardiomyopathy.
In fact, we discussed the risk vs reward because we wanted to start the Herceptin before scheduling could even start for the echoes and we decided that we can fix my heart but it’s much worse if the cancer is still there and spreads. So, I started the Herceptin and got 1 round in before the echo was performed. That echo in May 2022 showed my heart was at perfect levels.
I then repeated echoes in August 2022, and November 2022. I regularly read and research provider reports following these tests as my oncologist typically reviews and signs off as “good” or “all clear” and I want to ensure the full picture is seen. But, the tech who did my echo test in November made a comment that “EF” or Ejection Fraction was the number that made the difference and I was in normal range, which is between 50-65%. This gave me an indication of what to look for and compare to my previous echo reports.
Ejection fraction is a measurement of the percentage of blood leaving your heart each time it squeezes (contracts).
In review of all of the reports, I found my EF had declined. While it was still in normal range, this indicated cardiotoxicity from Herceptin. I then created a report that compared each echo report and Joe created a full spreadsheet analysis. I reached out to Virginia, who is an NP, and she pulled some strings to get my echoes reviewed by a local cardiologist. Within one week of my report I was seen by a cardiologist.
I learned that I do have some thickening of valves from radiation and this is not reversible but likely wouldn’t cause any problems. I also have what’s called cardiomyopathy caused by chemo and targeted therapies. Which means weakening of the heart. The main concern is to get as many treatments of Herceptin without reducing my heart’s function so much that I would need a heart transplant.
It’s a fine line and there’s no magic trick here. My doctor put it “are we robbing Peter to pay Paul?” We just don’t know. Meaning, are we staving off any future cancer cells but ruining my heart?
I also learned that cardiology is a somewhat objective profession. What one cardiologist sees and interprets on an echo might differ from the next. Having one review and report on all of my future echoes will be key in monitoring.
For now, the plan is to stay on course with the Herceptin infusions every 3 weeks. With a goal to keep going until May 2023. I will continue quarterly echocardiograms and my cardiologist will review. I have also started metoprolol, a beta blocker, with the hopes of slowing or stopping altogether, further cardiotoxicity.
Overall, I don’t have any symptoms from the reduction in my ejection fraction. And I likely won’t - if we keep it within normal range. But, the implications are huge. Living with heart failure is not an easy road.
The only thing I can do is monitor closely, keep my doctors alert, and stay vigilant. Which, as you know, I’ll continue to do.
