Radiation and chemotherapy fight cancer and save lives. But some patients develop heart problems during treatment and even years or decades later as a side effect of the life-saving treatment.
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Because of this, it is important for you to have cardiac screening tests before and after treatment. That way, your doctor may be able to prevent potential problems from occurring.
Tests your doctor may use
Doctors use several different types of tests to determine heart function before and after radiation therapy and chemotherapy. The tests include:
- MUGA scan. The multigated acquisition scan uses a small amount of radioactive tracer injected into a vein and a special camera to create images of the beating heart.
- Echocardiogram with strain testing. This is an ultrasound test that creates images of the moving heart and provides detailed information about the structures of the heart and how the heart muscle is functioning.
- Stress testing for exercise tolerance. In this type of test, you exercise on a treadmill while doctors monitor your vital signs such as heartbeat and blood pressure. When combined with echocardiogram, they obtain images of the beating heart before and immediately after exercise.
- Cardiac MRI. This is reserved for complicated cases or specific issues. A magnetic resonance imaging test creates a detailed 3-D map or image of the heart.
More about echo testing
Balaji Tamarappoo, MD, PhD, co-director of Cleveland Clinic’s Cardio-oncology Center, says, “Although the MUGA scan is a reliable test for measuring LV (left ventricular) function, an echocardiogram gives a more comprehensive look at both cardiac function and the function of the heart valves. When coupled with measurements of cardiac strain, it becomes more sensitive for detecting subtle changes in cardiac function.”
Echocardiography provides your doctor with a comprehensive evaluation of the heart’s function and structure, including the chambers and valves.
Strain imaging combined with echocardiography further evaluates the function of the heart muscle using cardiac ultrasound. This method is particularly useful in identifying subtle changes in heart function. Dr. Tamarappoo says strain imaging is better because it can detect changes in your heart’s performance even before they show up as clinical symptoms.
Dr. Tamarappoo explains that strain imaging provides two important sets of data: Left ventricular ejection fraction (EF) and LV strain (stress). “Abnormal LV strain will prompt us to recommend follow-up testing with echocardiograms to monitor for further changes in cardiac function,” he says. “We may also recommend treatment with cardioprotective medications.”
Treating heart issues
Medicines can help ease the burden on your heart if any impact occurs from cancer treatment. And they can help prevent the need for surgical intervention down the line.
After comparing initial and subsequent test results, Dr. Tamarappoo says, “If we find dramatic changes in LV strain, we can initiate treatment with beta blockers, ACE inhibitors and possibly statins to prevent further damage. We also will follow up with continued testing of these patients to make sure that heart function remains stable.”
What to do if you are scheduled for cancer treatment
Talk with your doctor about your cancer treatment and discuss testing for heart function. This testing will establish your “baseline” heart function. There is no “normal” and no two people share the same heart function. That makes it important to know what your pre-treatment function is. That way doctors can test afterward and compare the results.