Chemotherapy & Heart Failure
Chemotherapy & Heart Failure
Oncology patients are watched very closely for heart failure while they are in the midst of their treatment. Dr. Nikolas Krishna, cardiologist and medical director for the Advanced Heart Failure Clinic at Chippenham Hospital, explains why.
Content
3.03 -> - [Chemotherapy And Heart Failure,
Nikolas Krishna, MD, Director of the
Advanced Heart Failure Clinic]There's
a contingent of the patients that I see
4.89 -> who are patients who receive chemotherapy
7.38 -> or about to receive chemotherapy,
8.85 -> so they've been diagnosed
with a cancer diagnosis,
11.19 -> which is very unfortunate.
12.15 -> Here they are with this bad news,
14.04 -> on top of which they have to be told
15.6 -> that the chemotherapy they're gonna get
17.4 -> can take a toll on their heart.
19.89 -> And, as we talked about, their
heart can essentially go down
22.92 -> as an innocent bystander
24 -> because of the toxicity
of the chemotherapy.
26.7 -> So we'll do a screening echocardiogram
29.58 -> and take a look at the
function of their heart;
30.93 -> typically it'll be normal
32.61 -> unless they've had known
cardiomyopathy or weak hearts,
35.55 -> and now they have undergone chemotherapy,
38.34 -> and some of them develop a weak heart.
41.49 -> When we talk about heart failure,
43.44 -> there's different types of heart failure.
45.12 -> And the way we like to
tend to separate it,
48.6 -> and it's about 50/50, close to it,
50.28 -> is that the heart is
actually weak, it gets weak;
53.28 -> the squeeze of the hearts gets under 40%,
55.122 -> and by definition, that's
systolic heart failure.
57.69 -> And there's another group of patients
59.67 -> where the squeeze of the
heart is not the big issue;
61.62 -> it actually squeezes really well.
63.63 -> But the problem is, the heart
doesn't relax very well.
66 -> The heart's stiffer than it should be.
67.35 -> And we call that heart failure
69.03 -> with preserved ejection fraction.
71.1 -> There's a new nomenclature,
73.56 -> and in the heart failure world
we get very excited about,
76.65 -> and that's what do you do when
somebody's ejection fraction
79.53 -> is between 40 and 50% or that 41 to 49%?
84.15 -> So that is an area called heart failure
86.46 -> with mid-range ejection fraction.
89.76 -> So, essentially, when a
chemotherapy patient is coming in,
93.93 -> we are keeping a very close eye
95.25 -> on not just the function of the heart
97.08 -> but also the way it relaxes.
100.401 -> There's certain signs,
especially in the ultrasound,
103.438 -> of the heart, called strain imaging,
105.33 -> that suggest when the heart's
stiffer than it should be.
107.31 -> So these are the first signs.
109.59 -> When somebody gets chemotherapy,
111.15 -> it's not just within that
first few weeks or first year,
113.82 -> but for years on end and decades later,
116.52 -> they can have the effects of a weak heart.
118.83 -> So heart failure is always
121.178 -> something that can happen for them.
123.15 -> Their heart is more prone to heart failure
125.37 -> than a heart that did
not have chemotherapy.
127.53 -> And that's what we mean by how
they are typically stage A,
130.44 -> 'cause they are at risk for heart failure.
Source: https://www.youtube.com/watch?v=-_QIxC7157g