This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.

Heart problems

All parts of the body need oxygen, which is carried in the blood through the blood vessels. When we breathe, oxygen enters the bloodstream via the lungs and is then pumped through the rest of the body by the heart.

The heart is a large muscle that consists of 4 chambers: the right atrium, the right ventricle, the left atrium and the left ventricle. Atriums receive the blood from the body, while ventricles pump the blood into the body. The heart also contains 4 valves which open and close each time the heart beats. These valves ensure that the blood flows in the right direction.

Sometimes problems can occur with the heart, making it harder for the heart to pump blood through the body. Heart problems include:

  • Cardiomyopathy, where the heart muscle gets damaged.
  • Arrhythmia, where the heart beats irregularly or too fast or too slow.
  • Pericardial disease, which is caused by swelling or inflammation of the sack that surrounds the heart
  • Valvular heart disease, where one or more valves of the heart do not open or close properly.
  • Coronary artery disease, where there is not enough oxygen reaching the heart caused by narrow blood vessels. For more information on coronary artery disease, please read: Asymptomatic coronary artery disease.

There are a number of things anyone can do that may lower the risk of having heart problems, such as adopting or maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.

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Am I at higher risk of heart problems?

Anyone, including people who have never had cancer treatment, may develop heart problems. However, there are some cancer treatments that may increase the risk of having heart problems later in life. The problems that can occur depend on the type and dose of cancer treatment received.

The following treatments can increase the risk of heart problems:

  • Radiotherapy (15 Gy or more) to the heart or an area including the heart may cause cardiomyopathy, arrhythmia, pericardial disease or valvular heart disease.
  • A group of chemotherapy drugs called anthracyclines (total dose of 100 mg/m² or more) may cause cardiomyopathy. Examples of anthracyclines are doxorubicin, daunorubicin, epirubicin, idarubicin. Anthracyclines may also cause arrhythmia.
  • A type of chemotherapy drug called mitoxantrone can also cause cardiomyopathy and arrhythmia.
  • When radiotherapy is given together with anthracyclines and/or mitoxantrone, the risk of developing heart problems is higher.

Heart problems are more common after higher doses of treatment, but can occasionally occur after low doses. The risk of developing heart problems is higher if you were treated at a young age.

You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.

If you experience heart problems, it does not always mean that this is caused by your cancer treatment. Heart problems may have other causes, such as high blood pressure, being overweight, diabetes, high cholesterol (a fatty substance in the blood), smoking and older age. For more information on high blood pressure, overweight and obesity, diabetes and dyslipidemia please read: Hypertension, Overweight and obesity, Impaired glucose metabolism and diabetes and Dyslipideamia. If heart problems are common in your family, this may also increase your risk of having heart problems.

What are the symptoms and signs of heart problems?

There are symptoms and signs that can tell you if you might have heart problems. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.

These symptoms may suggest that you have heart problems:

  • Unusual shortness of breath, for example when walking up the stairs
  • Feeling very tired or weak
  • Dizziness or feeling lightheaded
  • Being unable to sleep when lying flat (needing to sit up)
  • Frequently needing to pee during the night (more than twice every night)
  • Swelling of the legs, ankles or feet
  • Chest pain or pressure on the chest
  • Fluttering sensation in the chest
  • Sweating a lot

These symptoms and signs are often caused by something else. However, if you experience any of these symptoms or signs, please contact a general practitioner or follow-up care specialist. If you have developed heart problems, early diagnosis and treatment is very important. If you already see a long-term follow-up specialist regularly, any heart problems will likely be picked up before you will experience any symptoms.

I am at higher risk of heart problems. What tests should I have and when?

If you are at higher risk of heart problems, it is advised to see your general practitioner or follow-up care specialist at least every 5 years. Depending on your cancer treatment, you may be advised to see a follow-up care specialist more often.

If you are at higher risk of heart problems, it is advised to:

  • Have your blood pressure, blood glucose (sugar) and cholesterol levels measured regularly. Your general practitioner or follow-up care specialist may also ask about smoking, your weight and your level of physical activity. These are factors that can increase your risk of heart problems.
  • Have an echocardiogram (ultrasound of the heart) at least every 5 years, starting 2 years after cancer treatment ended. Depending on the total radiotherapy and anthracycline dose, you may need to have an echocardiogram more often. If you wish to become pregnant, it is advised to do a repeat echocardiogram before the pregnancy and in the first trimester (week 1-12 of the pregnancy).
  • Have an electrocardiogram (ECG or EKG) once at entry into long-term follow-up (LTFU) and/or following your 18th birthday. Unless you start experiencing new symptoms in the future, the ECG will not have to be repeated.

Whenever you visit your general practitioner or follow-up care specialist, they may also:

  • Ask about your cardiac history (if any heart problems have been diagnosed in the past).
  • Do a physical exam.
  • Ask about your lifestyle.
  • Do a blood test. Sometimes, how well your heart is working can be detected in the blood and your follow-up care specialist may decide to do a blood test. However, a blood test alone is not sufficient to diagnose heart problems. Most likely, your doctor will perform other tests as well.

What happens if I have heart problems?

If you have heart problems, the general practitioner or follow-up care specialist will probably refer you to a:

  • Cardiologist (physician specialised in cardiovascular diseases)

The cardiologist may discuss different treatment options with you.

What else can I do?

Knowing that you may be at increased risk of heart problems can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.

If you are at risk of heart problems or experience any heart problems, it is very important to live a healthy lifestyle. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.

It is important that you are aware of the possibility of developing heart problems and that you know the symptoms and signs. If you have any further questions or the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.

Where can I find more information?

You may find more information about heart problems online. However, it is important to be aware that this information is not always up to date or accurate.

Some sources of further information are:

Together: Here you can find more information about cardiac late effects

On this website, you can also find more information related to this topic:

Please note

This PLAIN summary is based on the PanCareFollowUp guideline about “Cardiac problems” [1], which is based on the consensus of different national guideline, and the IGHG* guideline for ‘Cardiomyopathy’ [2].

While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.

Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.

*International Guideline Harmonization Group for Late Effects of Childhood Cancer

[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext.

[2] Ehrhardt, M.J. et al. (2023) Systematic review and updated recommendations for cardiomyopathy surveillance for survivors of childhood, adolescent, and young adult cancer from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Available at: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(23)00012-8/fulltext