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Asked by Leigh, Orlando, Florida
My husband had childhood leukemia, and his ejection fraction [the capacity at which the heart is pumping] has steadily declined over the last few years, the most recent results showed 39 percent, apparently as a result of the chemo he received. What treatments or medications are available for this? He is only 35 years old, which seems so young for heart problems.
Conditions Expert
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Dear Leigh:
Modern medicine has achieved a lot in terms of successful treatment of childhood leukemia and lymphoma. Some leukemias have a 75 percent cure rate. Some lymphomas have even higher cure rates.
The drugs and interventions used, however, can have serious side effects. Seventy-five percent of patients have one or more health problems related to chemotherapy. This can include second cancers, coronary artery disease, heart failure, lung problems and endocrine disorders (growth function and slow or delayed sexual development). One-fourth of patients have five or more health problems.
The heart failure is a muscle weakness. The heart muscle cannot contract and pump blood as well as it should. This is most often related to treatment with anthracycline chemotherapies, but other drugs can also cause it, as can radiation treatments to the chest.
Heart failure can be seen 10 to 15 years after treatment ends. A common symptom is shortness of breath with minor exercise. More severe heart failure causes swollen legs and the patient has difficulty breathing when lying flat.
A cardiologist should treat patients with this disease. The heart function can be assessed with an ultrasound of the heart called an echocardiogram or with a nuclear medicine test.
There are numerous medical treatments for heart failure. We typically progress in the following order as we treat mild to severe heart failure: First, we treat with salt-restricted diets, then with diuretics such as furosemide, which increases urination. This decreases the amount of fluid the heart has to pump and decreases the blood pressure the heart has to pump against. Angiotensin-converting enzyme (ACE) inhibitors such as enalapril and lisinopril are used to lower the blood pressure and the arterial resistance that the heart has to pump against. In the past decade or so, beta blockers, which slow the heart rate, have become popular in the treatment of heart failure. Digoxin, an old drug, is still used in severe heart failure. In extreme cases, a heart transplant is performed to treat severe heart failure.
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