Most people who undergo chemotherapy do not develop heart failure. However, specific chemotherapy drugs may significantly increase your risk of heart failure and other cardiac problems.

Chemotherapy is a powerful tool in the fight against cancer, but it can also come with serious risks and side effects, including the risk of heart failure.

Keep reading to learn how chemotherapy can affect your heart and what you can do to minimize this risk.

Certain chemotherapy drugs can negatively affect your heart health, a side effect known as cardiotoxicity.

Depending on the specific drug used for chemo, this risk can be quite common. For example, according to the European Society of Cardiology, high concentrations of doxorubicin can cause cardiotoxicity in up to nearly half of all people.

Heart failure is one of the most serious and potentially life threatening types of cardiotoxicity. Heart failure happens when your heart can’t pump blood as well as it should.

Some chemotherapy drugs can damage the heart muscle, making it weaker and less efficient over time. The risk of this complication is higher in people with cardiovascular disease (diseases that affect the heart or blood vessels).

In a 2023 study, people who received anthracycline-based chemotherapy (like doxorubicin) for breast cancer or lymphoma were more than 20 times as likely to develop heart failure within 1 year of treatment than people in the larger population.

Still, only a minority of people who receive chemo develop heart failure. In the same study, 1.81% of people who received chemo developed heart failure after 1 year, rising to 10.75% after 20 years, compared to 4.98% in people without cancer.

Other effects of chemotherapy on the heart

Apart from heart failure, cardiotoxicity from chemotherapy can include the following conditions:

Chemotherapy drugs that can cause cardiotoxicity include:

Heart damage from chemotherapy can happen gradually, so it’s important to have regular follow-up appointments with a doctor and know the symptoms and signs to watch for.

Symptoms you might experience include:

Doctors may also be able to detect signs of heart failure on certain tests:

  • Echocardiogram: This ultrasound of your heart shows how your heart and its valves are functioning. It’s the primary test to measure ejection fraction, which indicates how well your heart is pumping. A lower-than-normal ejection fraction can be a sign of heart failure.
  • Blood tests: Certain markers in your blood, like B-type natriuretic peptide (BNP), can indicate heart failure.
  • Electrocardiogram (ECG): ECGs record the electrical activity of your heart and can show if there are any irregularities.
  • Cardiac MRI: Heart MRI provides detailed pictures of your heart to detect damage.
  • Multigated acquisition scan (MUGA): MUGA looks at how well the bottom chambers of your heart (ventricles) are pumping blood out into your body.

If you develop heart failure due to chemotherapy, your treatment will likely involve a combination of heart medications and adjustments to your cancer treatment plan.

Medications that help treat cardiotoxicity include:

Can people with heart failure undergo chemotherapy?

Many people with heart failure can have chemo, but it requires careful planning. If you have heart failure, your oncologist and cardiologist will work closely to choose a chemotherapy regimen that minimizes heart risks.

You can take steps to lower your risk of heart failure during chemotherapy, including:

Your doctor may also prescribe you medications to prevent heart complications during chemo.

The outlook for people with heart failure from chemotherapy varies depending on the severity of the heart damage and how well it’s managed.

Early detection and treatment can significantly improve your outlook. With proper care, many people live with heart failure for many years.

Can you reverse heart damage from chemotherapy?

According to a 2021 review, heart failure from chemotherapy can be either reversible or irreversible. Even if the damage is irreversible, you can manage the symptoms and prevent further complications with the proper treatment.

How can I protect my heart during chemotherapy?

To protect your heart during chemo, stay active, eat a heart-healthy diet, avoid smoking and alcohol, and keep up with regular heart monitoring.

In some cases, your oncologist may recommend medication to help prevent heart failure. Be sure to communicate any symptoms to your doctor right away.

How can I strengthen my heart after chemotherapy?

After chemotherapy, continue healthy habits to strengthen your heart. In addition to focusing on a balanced diet, discuss starting a fitness routine with cardiovascular exercises with your doctor.

Can chemotherapy cause heart problems years later?

In a 2023 study, the risk of developing heart failure after anthracycline chemotherapy compared to the larger population was significantly higher for up to 20 years.

Other effects of cardiotoxicity can also develop years after treatment. For this reason, ongoing monitoring and healthy lifestyle choices are essential even after chemotherapy ends.

Chemotherapy is a powerful treatment against cancer, but it can also pose risks to your heart. Understanding these risks and taking proactive steps can help protect your heart during and after treatment.

Stay informed, keep up with regular checkups, and don’t hesitate to talk with your doctor about any concerns. With the proper care, you can continue your fight against cancer while keeping your heart as healthy as possible.