About Cardio-Oncology
Cardio-oncology is a field that treats heart issues in cancer patients.
Patients with cancer may have heart problems because of their cancer treatment. Certain cancer drugs or radiation treatments may cause harmful effects on the heart. Those conditions may need more specialized care.
When cancer treatment harms the heart, it’s known as cancer-treatment-related cardiotoxicity (CTC). CTC can happen during cancer treatment. However, complications can also appear many years after treatment finishes.
Cardio-oncologists are heart specialists. They prevent, detect, and treat heart issues that stem from cancer. They order tests, perform surgical procedures, and prescribe medication. They work to limit cardiac toxicities, with the ultimate goal of improving the survival and quality of life for patients.
The Cardio-Oncology Center of Excellence at WashU Medicine works closely with Siteman Cancer Center. Together, they work to prevent or reduce cardiac side effects.
Our Siteman care coordinators – oncology-trained nurses who help with scheduling, finding the right specialist, and guidance – can help you through the process.
Call us directly or submit a form, and we will call you back.
Why Choose Siteman
The Center for Cardiovascular Research at WashU Medicine brings together Hematology, Oncology, Radiation Oncology, and Cardio-Oncology. They work closely with WashU Medicine physicians at Siteman Cancer Center to provide the highest quality of care for our cancer patients.
In 2021, the Center earned the Gold Center of Excellence. This was the highest honor from the International Cardio-Oncology Society and was one of only 15 centers worldwide to achieve this ranking.
Clinical Expertise
The Center for Cardiovascular Research at WashU Medicine works with cardio-oncologists. Together, they study how the heart responds to cancer treatments. They develop new therapies to improve the lives of people living with cardiovascular diseases.
- Doctors screen patients for cardiac injury risk before starting chemotherapy. This helps identify existing risks to limit and prevent long-term damage to the heart.
- Doctors work with advanced heart failure programs. They focus on cardiac resynchronization therapy, circulatory assistance devices, and heart transplants.
- WashU Medicine physicians at Siteman educate other oncologists, cardiologists, and physicians in training.
- WashU Medicine physicians take part in clinical trials. They test methods to detect, prevent, and treat heart issues caused by chemotherapy.
- They enhance heart monitoring by using advanced cardiac imaging techniques.
Your Second Opinion at Siteman
Siteman wants to be your first choice for cancer care, but that might not always be possible. If you have received a cancer diagnosis, started care somewhere else, or are a physician seeking specialized care for your patient, ask us about a second opinion. You can start the process. To make it easy, our care coordinators guide scheduling for yourself or your patient.
What to Expect
Your doctor will track your heart before, during, and after treatment. If you have issues, your heart function may improve after finishing cancer therapy. Your doctor will let you know if you need to take medication. If you already are, they will let you know when you can lower your dose or stop taking it entirely.
Which heart symptoms does cancer treatment cause?
If your heart is not functioning normally, you might experience it as fatigue, shortness of breath, swelling in the legs, or chest pain.
Not all heart problems are noticeable, though. That’s why our heart specialists will order a heart test early on in your treatment. That way, they can check your heart health throughout your procedures.
Tests to check the heart
Doctors may order different tests throughout your treatment to check your heart activity. Some may be routine, like blood tests or imaging, but sometimes they might need a more thorough diagnosis. Common lab tests include:
- Echocardiograms (Echo): These tests are an ultrasound of the heart. They measure the volume of blood that pumps from your heart to track its stability.
- Electrocardiograms (ECG or EKG): These tests measure heartbeats by recording electrical signals from the heart. They can help doctors diagnose irregular heartbeats or heart attacks.
- B-Type Natriuretic Peptide Test (BNP): This blood test measures the levels of the BNP protein in your blood. BNP proteins help your heart pump more blood. Higher levels can indicate heart failure.
- Troponin Tests: These tests look for levels of troponin in your blood. Troponin is a protein that normally stays inside the muscles, but it can leak into your blood after cell damage. Troponin tests will look at one or two types of troponin proteins in the heart: troponin I or troponin T.
- Troponin I: a protein unique to the heart muscle
- Troponin T: a protein found in various muscle types. It has a unique structure in the heart that isn’t found in other body parts.
- Lipid Panel: A blood test that measures the amount of lipids, or fat molecules, in your blood. It measures five types of lipids from a blood sample: LDL, VLDL, HDL, total cholesterol, and triglycerides. You might also hear them called lipid profiles, lipid tests, cholesterol panels, or coronary risk panels. Some may need you to fast before your appointment, but not all do.
- Cardiac MRI Scan: These tests show detailed images of your heart without using any radiation. They will show doctors how well your heart’s chambers, valves, and muscles are working.
Medications used to treat cardiotoxicity
- Beta blockers. This preserves the muscle function of the heart. They can also stop heart problems caused by some cancer drugs, like carvedilol (Coreg) or nebivolol (Bystolic).
- ACE Inhibitors. These protect the heart during anti-cancer medication therapy. They include Lisinopril and Enalapril, among others.
- Spironolactone. This medication helps with leg swelling and shortness of breath from LVEF complications.
Childhood Treatment of Cardiotoxicity
WashU physicians have specialized experience in appropriate heart care for children. Experts from Siteman Kids, St. Louis Children’s Hospital, and WashU Medicine in the Cardio-Oncology Clinic support your kids’ heart health during and after treatment. We offer the same state-of-the-art healthcare to diagnose and treat cancer at every stage.
Risks & Effects of Cardiotoxicity
Potential heart toxicities from cancer treatments include:
- Arrhythmias
- Valvular heart disease
- Coronary artery disease
- Hypertension
- Heart failure and more
Your doctor will closely watch your heart throughout your treatment. They will inform you of any risks that appear along the way.
High blood pressure and hypertension
Some cancer medicines have a side effect of high blood pressure, also called hypertension. The prescriptions linked to this are anti-vascular endothelial growth factor (VEGF) medications.
VEGF is a protein that stimulates the formation of small blood vessels. When this medication is used for cancer, it helps block the blood flow to tumors, helping to shrink or eliminate cancer. However, this can affect other blood vessels in the body, which leads to hypertension.
Common medications can keep high blood pressure under control. Medications allow you to continue your anti-cancer treatment with limited or no interruptions.
What you can do to reduce hypertension
In addition to taking any medications prescribed by your doctor, you can also do the following to lower your risk of hypertension.
- Regular aerobic exercise
- Eat a diet that promotes heart health
- Reduce your salt intake
Reduced LVEF and cardiac dysfunction
One of the more common kinds of heart failure for patients with cancer is a reduction of the left ventricle ejection fraction – shortened to reduced LVEF. Your doctors might also call it cardiomyopathy or LV dysfunction.
The left ventricle (LV) pumps blood through your body. The ejection fraction (EF) refers to the volume of blood it pumps.
When the left ventricle is weak, the ejection fraction lowers. Doctors measure LVEF with different cardiac tests, like a cardiac MRI or electrocardiogram, to measure how much blood each heartbeat pumps.
If you show a reduced LVEF, then your doctor may intervene to prevent further heart failure.
Clinical Trials
Clinical trials are how we advance cancer care. By testing new and promising therapies, they are the key to discovering tomorrow’s standard of care and offering new hope for our patients.
As a National Cancer Institute-designated Comprehensive Cancer Care Center, we operate one of the nation’s largest clinical trial programs. This gives you and your care team access to a wide range of innovative trials, many of which are unavailable anywhere else. Your team will determine if a clinical trial is a good option for your unique needs.
Clinical trials are research studies that help us find new ways to prevent, diagnose, and treat cancer. If you have a rare or complex diagnosis or your treatment path seems uncertain, you might qualify for a clinical trial.
Our team will help you find a study that is right for you. Call us to speak with a Siteman care coordinator.
Frequently Asked Questions About Reduced LVEF
Some anti-cancer drugs, especially anthracyclines like doxorubicin, can weaken the heart. This reduces how well the heart pumps.
Your doctor may prescribe heart medications at different phases during your cancer therapy. The prescriptions will improve your heart’s function and prevent the condition from worsening.
When doctors find reduced LVEF early, the heart muscle can recover. With the right treatment, the LVEF percentage may improve.
In some cases, your doctors may pause your cancer therapy to allow your heart muscle time to rest and recover. Once your heart stabilizes, you can resume treatment.
Nurses at Siteman answer every call and every form. Speak with them directly 8:00 am to 4:30 pm CT Monday- Friday for guidance on appointments, second opinions, and referrals.
