Late Effects: Heart Valve Disease/Replacement

Max Former Hodgkins Stage 3 said:

Heart damage

G,

I never received therapeudic radiation, but studied it quite a bit last year in reference to finding a treatment for my prostate cancer.  Radiation today is light-years ahead of what it was in 1987, and today causes a lot less damage to adjacent tissues than it did even ten years ago or less.  So a patient considering radiation for lymphoma today would have less cause for pause as regards healthy tissue damage than would have been reasonable then. Of course, in 1987, options may have been much less, and radiation, since it cured your lymphoma, most likely was something anyone would have done. Therefore, if a patient describes their "heart damage due to radiation they received for lymmphoma," be sure you are comparing apples to apples. The technology employed for delivery must be the same to make a reasonable comparison between your case and their's.

That does not address your question of what damaged your heart then. Hopefully someone here will have some responses for you. There was a woman named Kathy writing here regularly until about a year ago. She was very expert in secondary diseases derived from lymphoma treatments, and knew a great deal about long-term follow-up after treatment.  Perhaps she will read this and comment; she had wonderful links for all questions.  Of course your cardiologist should also have historical information on a radiation/valve damage link.

Regaring heart damage from chemo, the most common link is Adriamycin, which is one of the drugs in both ABVD (usually for Hodgkin's) and in CHOP (the most common first-line treatment for most forms of non-Hodgkin's).  There of course is not an "A" letter in the abbreviation  "CHOP".  Virtually all chemo drugs have at least two or three common names in oncology, and Adriamycin is indeed the drug referred to by the "H" in "CHOP," but why it is exppressed as an "H" I have never read.)   Adriamycin is also very commonly used for many other cancers, including breast, and is the famous "red devil" drug that causes urine to turn pink or red for a day or so following infusion.  It can cause a form of congestive heart failure through a thickening of the heart muscle tissue, but I am not certain if this involves damage to a particular valve.  My long-term followup sent me for a heart ultrasound about a year ago, to have me tested for this form of heart damage, and they send all heavy users of Adriamycin for this test, five years after chemo has ended.  I received a LOT of the drug, or about 140% of recommended lifetime.  The ultrasound was looking for a value known as ejection fraction, and fortunately mine was normal.  Ejection fraction refers to the force blood is ejected out of the heart; a perfect or idea score is "65%", for some reason. When the tech told me I was "around 65%", I thought I was a goner until I had done a bit of reading on the subject !

Regarding ejection fraction:  http://en.wikipedia.org/wiki/Ejection_fraction

Adriamycin can cause heart damge for up to around ten years after application (estimates of how far out Adriamycin can cause heart damage vary a good bit), so it is indeed a long-term issue for people who received it in large doses to be aware of.  Damage is usually dose-related, so patients who received only a few infusions are much less at risk. 

Full damge to the heart from Adriamycin is still fairly rare, occuring in only 1% to 2% of users.  Cardiologist themselves are very aware of the issues Adriamycin can cause, and if they know a patient received chemo, will ask about it.

I hope your recent surgery keeps your heart well for decades.  If you ever received CHOP or ABVD, you may want to read the link provided.

max

Regarding Adriamycin:  http://chemocare.com/chemotherapy/drug-info/adriamycin.aspx

Regarding cardiac toxicology from chemo drugs in general: 

http://www.texasoncology.com/cancer-treatment/side-effects-of-cancer-treatment/long-term-side-effects/cardiac-toxicity/

 

max

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Thank you Max.