Acute myeloid leukemia (AML) is a form of cancer that begins in the bone marrow and can quickly move into the blood. Treating AML often involves a type of chemotherapy drug called anthracyclines.
Research in recent years, including a 2020 study, found a strong connection between anthracyclines and an increased chance of heart failure and other cardiac problems in people with AML.
Heart failure is a potentially life threatening condition. However, recent advances in diagnosis and treatment suggest that it may become more manageable in the years ahead.
AML is associated with heart problems in two main ways. First, the disease itself raises the risk of heart infections. Second, a common form of chemotherapy used to treat AML has been linked to heart failure and other cardiac conditions.
AML can trigger many symptoms, such as fatigue and headaches. Complications from AML and AML treatment can also put your heart’s health at risk. The following are a few common causes of heart conditions that can develop in people with AML.
AML causes abnormal white blood cells to form, which, in turn, weakens your immune system. This makes you more susceptible to many kinds of infections.
An infection that reaches the heart can cause inflammatory cardiac conditions such as:
These conditions can affect the heart’s functioning, and myocarditis can weaken the heart. They can also lead to heart failure, a condition in which the heart can no longer pump with enough force to meet the body’s demand for oxygenated blood.
Common chemotherapy medications can cause cardiac toxicities. These are injuries to the heart caused by a toxin. In the case of AML, a type of chemo drug called anthracyclines are often used and can be toxic to the heart while destroying cancer cells.
Two heart conditions linked to anthracyclines include left ventricular dysfunction and arrhythmias. Left ventricular dysfunction is when the left ventricle cannot squeeze properly. Arrhythmias are abnormal heart rhythms. In both cases, the abnormal activity can weaken the heart muscle over time and cause heart failure.
Despite these concerns, a
Bleeding and stroke
In addition to abnormal white blood cell production, AML can cause reduced platelet levels. Platelets are necessary for blood to clot properly.
Bleeding complications related to AML range from frequent bruising to hemorrhages in various organs. When a hemorrhage affects the brain, it can cause an event known as a hemorrhagic stroke. A
Early heart failure symptoms are common to other conditions, so it’s important to take note of any signs that your health is changing and talk with a doctor as soon as you can. Among the most obvious symptoms to look out for include:
- shortness of breath, especially when:
- lying down
- lying flat
- lying on extra pillows
- swelling in the lower legs
- coughing, often with blood-tinged mucus
- sudden, unexplained weight gain
- lack of appetite
- trouble concentrating
- chest pain
Signs of AML include:
When to seek medical attention
If you’ve been diagnosed with AML, your doctor may have given you a list of symptoms to watch out for or signs that complications may be developing, either from the cancer itself or from treatment.
While some symptoms, such as fatigue, may not be medical emergencies, they should be addressed with your doctor, as they may be a sign of something more serious. The following symptoms demand immediate medical attention:
- Shortness of breath. This can indicate worsening heart health or a pulmonary embolism (blood clot in the lung).
- Chest pain. Chest pain can either signal heart disease or cancer that’s progressing.
- Sudden swelling in the lower legs or unexplained weight gain of at least 5 pounds a week. Both suggest there’s a pooling of fluids caused by the heart’s weakened pumping ability or problems with other organs that help with fluid regulation, such as the kidneys or liver.
When dealing with leukemia and a heart condition, you should try to work with a cardio-oncologist — a cancer specialist who also focuses on heart health. A cardio-oncologist can help guide your treatment so that your cancer therapy is less risky for your heart.
One positive note is that most chemotherapy side effects lessen or disappear once treatment ends.
In mild cases of heart failure, lifestyle adjustments are usually recommended either before or during chemotherapy to minimize heart damage. These adjustments can include:
- not smoking
- eating a balanced diet
- exercising regularly
The next line of treatment includes medications, many of which are blood pressure-lowering (antihypertensive) drugs and medications that can help ease the burden on the heart. These include:
Whether your heart failure is triggered by AML or not, other treatments can include implantable devices to help strengthen your heart’s pumping ability and maintain a steady heartbeat. In the more advanced cases, a heart transplant may be necessary.
AML weakens the immune system, leaving the heart vulnerable to infection. Additionally, the type of chemotherapy often chosen to treat this cancer contains the medicine anthracycline, which may also damage the heart.
Heart failure is a severe complication of AML and may require medications and implantable devices for complete treatment.
Working with a cardio-oncologist early on means you will have someone who specializes in heart and cancer treatment overseeing your care.