Breast Cancer Patient Develops Pulmonary Hypertension, Other Heart Issues, After Chemo and Radiation

A patient treated with chemotherapy and radiation after breast cancer surgery developed pulmonary hypertension and other heart complications, according to a case study.

Researchers called for doctors to watch for patients at high risk of heart damage due to cancer therapy, and recommended echocardiography for the detection of such cases.

The study, “Multiple Cardiac Complications After Adjuvant Therapy For Breast Cancer: The Importance Of Echocardiography – A Case Report And Review Of The Literature,” was published in the journal Medical Ultrasonography.

Post-surgery therapies for breast cancer, such as chemotherapy and radiotherapy, improve patients’ outcome and survival. But they are associated with several acute and late cardiovascular complications that may account for increased morbidity — or the development of other diseases — and mortality among cancer survivors.

Researchers reported the case of a 54-year-old woman who had heart failure due to damage from breast cancer post-surgery treatment.

A month before going to the hospital for heart failure, the patient had dyspnea, or shortness of breath, when she engaged in moderate activity. She had paroxistic nocturnal dyspnea, or cardiac asthma, a week before hospitalization.

The patient had breast cancer surgery six years ago. Afterward, she was treated with chemotherapy and radiotherapy. The patient had no signs of cardiovascular disease before her breast cancer diagnosis and no significant cardiovascular risk factors.

The physical, chest and cardiac examinations and laboratory tests she took when hospitalized were considered normal. However, echocardiography detected severe certain heart complications — biventricular systolic dysfunction, mitral and tricuspid regurgitation, and pulmonary hypertension.

The heart failure treatment the patient took had a favorable outcome. When she was discharged, she doctors recommended cardiac surgery to assess whether she needed atrioventricular valvular reconstruction.

“The benefic effect of radio- and chemo- therapy on survival is counterbalanced by the risk of side effects, among which cardiac damage is the most severe,” the researchers wrote. “Radiation induced heart disease (RIHD) is a heterogeneous condition and includes pericarditis, myocardial fibrosis and cardiomyopathy, coronary artery disease, valvular disease and arrhythmias. Patients with breast cancer (especially left breast cancer) and Hodgkin disease represent the largest population exposed to chest radiation.

“Identifying patients with high risk for cardiac damage due to cancer therapy is very important and cardiac imaging evaluation of patients before, during and after therapy is mandatory, along with clinical evaluation,” the team concluded. “Young age and left anterior thoracic radiation are considered significant risk factors for cardiac damage and these patients should be carefully followed in order to detect subclinical changes. The most useful imaging technique is echocardiography because of its large availability, easy repeatability, accuracy and safety.”