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Treatment and the treatment process

Monitoring the heart

Some leukemia medicines can affect the heart. Checking the heart before and during treatment helps spot risks early.

Last updated: ~2 min read
On a dark navy background, a heart glows warm red and gold, surrounded by a translucent teal protective aura.
Figure 1.The heart is protected during treatment.

01Short answer

Several groups of leukemia medicines can affect the heart. Anthracyclines (daunorubicin, idarubicin, doxorubicin) can weaken the heart muscle — the risk depends on the total cumulative dose, age and any previous heart disease. Some targeted drugs can prolong the QT interval (such as certain tyrosine kinase inhibitors and arsenic trioxide), cause rhythm problems (for example, atrial fibrillation sometimes with ibrutinib), raise blood pressure or cause blood vessel problems. So an ECG and echocardiogram are usually done before treatment, and during treatment blood pressure, pulse and electrolytes are checked, with repeat ECG and echo when needed. Cardio-oncology — oncologists and cardiologists working together — helps reduce the risks.

02Simple explanation

The heart is sensitive. Some medicines affect heart muscle and rhythm.

Checks first. ECG and echo show the starting point.

Regular monitoring. Blood pressure, pulse and blood tests.

Teamwork. A cardiologist joins when needed.

03Scientific explanation

Anthracycline cardiotoxicity: cardiomyocyte injury via oxidative stress and topoisomerase IIβ; risk relates to cumulative dose. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are tracked by echocardiography, with troponin and NT-proBNP as supporting markers. Dexrazoxane or liposomal forms are considered in some cases.

QT prolongation: arsenic trioxide, some FLT3 and BCR-ABL inhibitors, azoles, some antiemetics and antibiotics; risk rises with low potassium and magnesium. QTc is followed on the ECG.

Other effects: atrial fibrillation and hypertension with BTK inhibitors, vascular events with some BCR-ABL inhibitors, and fluid retention in differentiation syndrome on ATRA or arsenic. The ESC 2022 cardio-oncology guidelines recommend risk assessment before treatment.

04What happens in the body?

How is the heart protected?

Risk is assessed, doses of heart-affecting medicines are tracked, and risk factors such as blood pressure and blood sugar are kept under control.

What does an ECG show?

An ECG records the heart’s electrical rhythm. It can show rhythm problems and a prolonged QT interval. It is painless and takes a few minutes.

On a dark background, a smooth gold ribbon of light shaped like a heart rhythm trace.
Figure 2.An ECG shows the heart’s electrical rhythm.

Echocardiogram

Ultrasound shows the heart’s chambers and how strongly it pumps. The result is used for comparison during treatment.

Teal sound waves reach a soft heart outline with visible chambers.
Figure 3.An echocardiogram shows how strongly the heart pumps.

05A heart monitoring plan

A simplified outline.

Baseline tests — ECG and echo.1Baseline testsECG and echo.
Rhythm checks — ECG when needed.2Rhythm checksECG when needed.
Blood pressure and pulse — Regularly.3Blood pressure and pulseRegularly.
Cardiologist — When there is risk.4CardiologistWhen there is risk.
Heart protectedRisk factors managed.
Early detectionChanges before symptoms.
Long-term follow-upAfter anthracyclines.

06Medicines that can affect the heart

GroupExamplesWhat is monitored
AnthracyclinesDaunorubicin, idarubicin, doxorubicinHeart muscle strength (echo)
Arsenic trioxideAPL treatmentQT interval, electrolytes
BTK inhibitorsIbrutinib and similarRhythm, blood pressure
BCR-ABL inhibitorsSome of themBlood vessels, QT, blood pressure
Supportive medicinesAzoles, some antiemeticsQT interval

* Your team decides the medicines and how often monitoring is done for you.

07Key terms

ECG
A recording of the heart’s electrical rhythm.
Echocardiogram
An ultrasound scan of the heart.
LVEF
The share of blood the left ventricle pumps out with each beat.
QT interval
The time for the heart’s electrical recovery on an ECG.
Cardiotoxicity
Harmful effect of a medicine on the heart.
Cardio-oncology
The field focused on protecting the heart in people with cancer.

08Key points

  • Some leukemia medicines can affect the heart.
  • An ECG and echo are usually done before treatment.
  • Potassium and magnesium matter for rhythm.
  • If you have heart disease, be sure to tell your team.
  • Chest pain and breathlessness are emergencies.
  • Long-term follow-up is advised after anthracyclines.

09Frequently asked questions

Will an anthracycline definitely harm my heart?

No — most people have no serious damage; the risk depends on dose and other factors and is monitored.

Should I keep taking my heart medicines?

Yes, unless your doctor says otherwise; give your team the list, as interactions are possible.

Why so many ECGs?

Some medicines affect rhythm; ECGs allow this to be watched safely.

When should my heart be checked after treatment?

It depends on the medicines you had; your doctor will give a follow-up plan.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Will an anthracycline definitely harm my heart?

  2. Should I keep taking my heart medicines?

  3. Why so many ECGs?

  4. When should my heart be checked after treatment?

My questions

12Sources

  1. Canadian Cancer Society. Heart problems
  2. Macmillan Cancer Support. Cancer treatment and heart health
  3. MedlinePlus. Electrocardiogram
  4. MedlinePlus. Echocardiogram
  5. European Society of Cardiology (ESC). 2022 ESC Guidelines on cardio-oncology
  6. Cancer Research UK. Types of acute myeloid leukaemia (AML)
  7. Leukemia & Lymphoma Society. Genetic testing and AML
  8. ESMO. ESMO Clinical Practice Guidelines: Haematological Malignancies
  9. American Cancer Society. Informed Consent
  10. National Cancer Institute (NCI). What Are Clinical Trials?
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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