Cancer Treatment Induced Heart Disease

Hi again Inali, as I read more about CAD and RIHD, I learn more. It seems my article about the "bypass various blood vessels" did NOT seem a good fit for what you are experiencing. So, I apologize for sending that post reply to you a day or so ago.//Starting over and my questions for you, being much further down this road than me. It seems my RIHD/CAD will get worse. I'm trying to figure out some in advance what I'll agree to and not agree to from Drs based on long-term results. I'd hate to have to wait until a full-blown heart attack to do something. But, at least then, it sounds like the Coronary Arteries (CAs) would be intact enough for Bypass surgery. That's where I felt heartened (Pun?) about "bypass various blood vessels" article. But, for you with your bad stent experience, further heart surgery and/or procedures is not for you. I DO hear you and know that you know your own body best, of course. I am just scared about the stent option being a bad one for me too and hurt my surgery chances down the line. SO, here are my questions for you if you'd be so kind as to consider answering them: 1. How long ago did you have your stents inserted? (It sounds like the most recent medication laced stents have less side effects and cause less inflammation) . 2. Did you feel pain because of the stent(s) in coronary arteries? 3. Did you have a heart attack before having the stent(s) inserted? 4. Would you advise people to avoid or shun having stents put in, period, due to your own experiences? 5. When arteries are severely clogged and Drs. suggest angioplasty and stents, are there ALTERNATIVES you know of that I could request instead? I would appreciate anything you could tell me since I'm feeling very anxious about my future too, off and on (soon, I'll head out the door for a walk which will at least relax me some). Hope your day is good. Marti

Hi Marti,
I'm happy to answer your questions:

1. Stents were inserted April 2017. I was still in the process of seeking a diagnosis for my shortness of breath. All pulmonary and cardio tests found nothing. I went to a new cardiologist two hours drive from my home. This is the highest rated hospital in the state. She suggested another stress test. I said 'and what if that shows nothing of significance?' - which had been the case with previous tests - she said, then we'd do a cardiac cath next. I said then let's just do the cath. During that procedure, blockages of the RCA were found, and stents inserted. Problem solved -- or so I thought...

2. No pain.

3. No heart attack (so far - knock on wood!)

4. Due to my experience, and what I now know, I would advise a candid conversation with doc/surgeon regarding the much higher likelihood of restenosis after stenting in those with RIHD. Considerations include the potential effectiveness of medication treatments, vs the risk to heart of a 100% occluded artery. Apparently, much depends on which artery is blocked. Also good to discuss any future surgical interventions that may be necessary, including CABG, and to what extent the stenting might further complicate those. My artery was apparently a challenge in that the blockage was at a 'hockey stick' point, or practically 90 degree turn, making stenting difficult. I was not as aware as I should have been that the cath was more than just a diagnostic tool; I should have realized more acutely that profound and unchangeable actions could be taken while I was having the procedure done. It is fortunate that you ARE aware and are asking all the right questions so that you can be well informed and manage your expectations accordingly.

5. There certainly ARE medications designed to fight the build-up of plaque (statins) and prevention of clots (blood thinners). Prior to my cath, I was taking no medication of any kind. Following what was learned about my condition during the cath, my cardiologist prescribed five: clopidogrel, atorvastatin, metoprolol, furosemide, and potassium. This procedure and an echo also revealed the valve issues and I received - for the first time - a diagnosis of congestive heart failure. Just a little icing on the cake of the CAD. If you and your doc agree, I suppose you could try the meds for a time and see if the progression of your condition slows or halts as a result of that and major lifestyle adjustments. Wouldn't that be wonderful? If you are having no symptoms at this time, your doc might consider that option reasonable. As we saw in the Widowmaker, stenting is pretty commonplace now, but it is not a magic bullet for everyone.

Let me know what you decide. These are not easy decisions. It is hard to predict outcomes for RIHD patients when each of our situations is so very unique. One awesome thing you have going for you is the fairly early discovery that you have it so that you have time to make adjustments in those areas of your life over which you have control - including having those candid discussions with your health care providers.

Hi Joan,
I notice that Colleen has not yet responded to you, so I thought I'd jump in with my 2 cents. I absolutely think it important that you talk to your doctor about the potential impact of radiation on your heart. Regardless of which came first. If you already have heart disease, radiation therapy could help escalate an existing condition. And it might not. But you should certainly alert your medical provider so that they know to watch for the signs.

Hi @inali @martijwis and @sakota, I'm just catching up with this discussion now.

Marti, you're right that heart disease related to cancer treatments should be discussed with cancer patients. Mayo cardiologists published this paper on the topic back in 2014
- Evaluation and Management of Patients With Heart Disease and Cancer: Cardio-Oncology https://www.mayoclinicproceedings.org/article/S0025-6196(14)00475-3/pdf

Thank you for your permission to share your comments with Mayo experts.

Joan, I agree with Inali. Please raise the topic of cancer treatment and its affects on your heart, especially if you already had heart disease before cancer. Before my father had cancer treatments, they conducted specific heart tests to better understand the condition of his heart, the possible impact of treatment and how to effectively avoid potential issues. His heart was monitored during treatment too. Did you have tests done before treatment that you're aware of?

Thank you so very much, Inali, for answering my questions so clearly. I am still learning and was feeling overwhelmed the past couple of days. I didn't even know that "bypass" and CABG (graft) were about the same thing. I am so so sad to hear of the diagnosis of congestive heart failure. I now understand even more why you feel exactly as you do.

I am on atorvastatin (Lipitor) now as well as vitamin K2 and CoQ10. Supposedly, K2 helps the body process calcium so that it goes more into the teeth and bones instead of kidney stones (which I had) and calcium in coronary arteries--as found in the CCS test. Many people are deficient in K2 and I think I am too.

I do know that my downing of the calcium units my Dr. prescribed for my osteopenia was a bad thing also. Articles came out a little after my kidney stone problems began in 2012 that stated that many menopausal women are now getting kidney stones most likely from the calcium carbonate pills they're taking. I take algae calcium now 1-2 times a week only and try to get the rest of calcium from spinach and organic milk along w/ vitamin D3 and magnesium pills on occasion.

I've felt a heaviness in my heart area off and on for a year. Had some shortness of breath 3 years ago but that went away with more regular exercise and some weight loss. Have minor chest ache when turning a certain way suddenly, like to grab something on my left off an end table, for example.

Will just keep monitoring how I'm doing on these pills I'm taking for now until seeing regular Dr. in May.

Your information and suggestions are invaluable to me and I again am so sad about the resistance to recognizing RIHD by so many in the medical field until just very recently. i will be extremely reluctant to get the stents, even the newer medication-laced ones. It sounds like some hospitals might do CABG for those of us with RIHD now when our arteries are very clogged and heart attack seems very likely.
That seems the best route to me at this time after all you wrote.

I would probably choose going to Mayo, like you. I read the articles from the Cleveland Clinic, as you know. But, know, as you said that one of the Drs. resistant to CCS is still on staff there as you said AND it's a long way from our house. We do live about 100 miles from Mayo and it seems like they are fully "on board" w/ CCS, RIHD, and the most up to date procedures, if any, that can help us.

Again, thank you so much for your wisdom and willingness to share it. Please keep in touch and let me know how you are doing. I admire your strength and honesty. Marti

Thank you for the link, Colleen, to the Mayo article re: heart disease and cancer from 2014. Also, I appreciate your willingness to possibly share my comments w/ Mayo experts especially in regard to Coronary Calcium Scan for early detection of heart disease of us cancer patients who are at high risk due to radiation treatment. I am becoming more aware now of Mayo's expertise in acknowledging and treating RIHD. We'll see how things go with the treatment I'm getting now in my area. If I need better options/procedures in the future, I'll seriously consider coming to Mayo.

Thank you colleen and inali for answering my question....... I had a thorough heart check up when I went to mayo the first time and they found the lung cancer. I've been trying to stay upbeat about all this but it is slowly dragging me down..... Have my ct scan in april and am concerned about that....... my copd is getting worse and now I am learning about the heart problems with radiation. whats going to be next. I know a lot of you are worse off than I......... how do you do it, how do you keep a positive attitude. I try to keep busy. but its getting hard.

Hi Marti,
You are so fortunate to be so close to Mayo! Our drive is about 7 hours, so even to go for a one day consultation is a major effort. However, Cleveland Clinic is even further away, so tempting as it is to check in there for a consultation because of their Radiation Heart Disease Clinic, that'll need to be a pass for us. There comes a time when you just need to put your faith in the skill of your doc/surgeon to handle whatever is encountered. My surgery at Mayo is a little over a month away, so I'm leaning into that and tamping down my tendency to keep wanting to investigate other options. I've got to get busy putting plans in place for family/friends to visit while I'm hospitalized and/or recovering there in Rochester. Temporary (affordable) housing is not easy to come by in that area - I guess because it is in such demand.

You always share such interesting/intriguing things 🙂 I'd never heard of Vitamin K2 until you mentioned it. I checked it out, but seems to be something I have to skip due to the blood thinners I'm on and likely to remain on indefinitely following valve replacement surgery.

It seems I've managed to acquire pretty much all the heart structural problems possible from radiation. Still, I have to keep in mind that I could be much worse off. The biggest challenge is to keep positive and focused on the good things in life. I could easily dissolve into feeling sorry for myself and retreating into a hermit-like existence. I fight everyday to keep as active as I can, and to communicate with family and friends about topics that are life affirming and uplifting. At the same time, I'm sounding the alarm to those I know who've had radiation to the chest for breast or other cancers. At the very least, they should consider having the CCS!

You are clearly focused on doing all you can to keep yourself healthy and expand your knowledge of your condition. I am certain that your commitment will enable you (with the assistance of your health care providers) to slow the progression of this horrid disease while more effective treatments are found.

Keeping positive is a daily challenge. I tell myself I'm ready to go and I'm not afraid of dying, but then I get angry about all the things I still want to do before I die. As my abilities and mobility decline, I'm able to do less. I find that to be the most frustrating of all. The important thing is to truly enjoy and immerse yourself in activities you love. I love to read, and for the last 30 years have been so totally immersed in my career that I hardly ever read for pleasure. Now I can indulge that passion as much as I like. I read hard copy, ebooks, and listen to audio books -- depending on my mood. One of my favorite things to do is listen to my audio book on my smart phone while doing laundry. It's a little thing, but I get that sense of accomplishment and being useful while listening to a fascinating story. Video chatting with my grandsons is a source of great joy for me. I'm able to spend time painting and drawing - other old hobbies I set aside while chasing the almighty dollar. Learning of my health condition, if nothing else, led me to finally retire. Without that, who knows how long I would have continued to work. Just look for the little things that "spark your joy" - that is the best way I know to stay positive.

Is the CCS the same as an angiogram? If you have a bad CCS would it show the same on angiogram?