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After treatment and remission

Heart

Some medicines used to treat leukaemia, especially anthracyclines, can affect the heart years later. This topic explains what the risk depends on, how the heart is checked and how to protect it.

Last updated: ~3 min read
A healthy heart works in a calm rhythm
Figure 1.A healthy heart works in a calm rhythm.

01Short answer

Anthracyclines (for example daunorubicin, doxorubicin and idarubicin) are among the main medicines for acute leukaemia. They can affect heart muscle cells and sometimes, years later, weaken the heart’s pumping function (cardiomyopathy, heart failure). The risk depends on the total (cumulative) dose, age at treatment (children and older adults are more sensitive), chest radiation, transplant, and factors such as high blood pressure, diabetes, high cholesterol and smoking. The ESC 2022 and COG guidelines recommend regular echocardiograms for these people according to dose and age. The main ways to protect your heart are controlling risk factors, regular activity, not smoking and telling your doctor about symptoms in time.

02Simple explanation

Anthracyclines can affect the heart.

Risk depends on total dose and age.

The heart is checked with an echocardiogram.

Keep blood pressure, sugar and cholesterol under control.

Report symptoms in time.

03Scientific explanation

Mechanism: anthracyclines cause oxidative damage and DNA damage via topoisomerase IIβ in heart cells; lost cells renew very little (ESC 2022).

Dose: the COG shows risk rising with total dose as doxorubicin equivalent; from about 250 mg/m² risk is considered high.

Screening: the COG recommends an echocardiogram every 1–5 years for people who received anthracyclines, depending on dose and age.

Cardiovascular risk factors: high blood pressure, diabetes and dyslipidaemia increase the effect of anthracyclines; treating them reduces risk (ESC 2022).

04What happens in the body?

How do anthracyclines affect the heart?

The medicine destroys leukaemia cells but can also damage heart muscle cells. Heart cells renew very little, so the effect may show years later.

Heart muscle fibres with a few slightly dimmer areas.
Figure 2.Anthracyclines can affect heart muscle cells.

Who is at higher risk?

People who had a high total dose, were treated as children or after 65, had chest radiation, had a transplant, or have high blood pressure, diabetes or smoke.

How is the heart checked?

An echocardiogram — an ultrasound scan with no radiation. Sometimes an ECG, blood tests (such as natriuretic peptide) or a cardiac MRI are also used.

How to protect your heart

Have your blood pressure, cholesterol and sugar checked, do not smoke, stay active and keep a healthy weight. This protects the heart’s reserve.

A soft ring of light around a clear arm.
Figure 3.Blood pressure control protects the heart.

Pregnancy and intense sport

If you received anthracyclines, a heart check may be advised before pregnancy or very intense sport.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05Protecting the heart

Steps of heart follow-up.

Dose — Know your total dose.1DoseKnow your total dose.
Echocardiogram — Checks on schedule.2EchocardiogramChecks on schedule.
Risk factors — Pressure, cholesterol, sugar.3Risk factorsPressure, cholesterol, sugar.
Activity — Regular activity.4ActivityRegular activity.
HeartFunction is monitored.
RiskFactors under control.
LifeAn active life continues.

06Heart risk and checks (simplified)

FactorWhy it mattersWhat to do
Anthracycline doseRisk rises with doseKeep it in your summary
Chest radiationAffects heart and vesselsRegular checks
High blood pressureIncreases the loadMeasure, treat
Diabetes, cholesterolDamage blood vesselsTests, treatment
SmokingGreatly raises riskStop

* Your doctor sets the echocardiogram schedule.

07Key terms

Anthracyclines
A group of chemotherapy medicines (daunorubicin, doxorubicin and others).
Cardiomyopathy
Disease of the heart muscle.
Heart failure
The heart not pumping enough blood.
Echocardiogram
An ultrasound scan of the heart.
Ejection fraction
The share of blood the heart pumps out with each beat.
Cardio-oncology
The field dealing with heart problems linked to cancer treatment.

08Key points

  • Anthracyclines can affect the heart.
  • Risk depends on dose and age.
  • Echocardiograms on schedule.
  • Control risk factors.
  • Do not smoke.
  • Report symptoms at once.

09Frequently asked questions

I received anthracyclines. Will I definitely have heart problems?

No, most people do not have serious problems; but follow-up matters.

How often should I have an echocardiogram?

Every 1–5 years depending on dose and age; your doctor decides.

Can I exercise?

Yes, regular moderate activity is good for the heart; talk to your doctor before very intense sport.

If a problem is found, is there treatment?

Yes, treating heart failure early with medicines is effective.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

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. I received anthracyclines. Will I definitely have heart problems?

  2. How often should I have an echocardiogram?

  3. Can I exercise?

  4. If a problem is found, is there treatment?

  5. Does this information replace medical advice?

My questions

12Sources

  1. European Heart Journal, 2022. Lyon AR et al. 2022 ESC Guidelines on cardio-oncology
  2. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  3. National Cancer Institute (NCI). Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version
  4. MedlinePlus (U.S. National Library of Medicine). Echocardiogram
  5. MedlinePlus (U.S. National Library of Medicine). Heart Failure
  6. National Cancer Institute (NCI). Follow-Up Medical Care
  7. National Cancer Institute (NCI). Cancer Survivorship
  8. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  9. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
  10. Cochrane Database of Systematic Reviews, 2015. Interventions to enhance return-to-work for cancer patients
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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