Cancer survivor late cardio toxicity associated with pregnancy.

1. Cancer & Heart Failure
“ Dual Epidemic “
Dr Asadullah Khan Soomro ,Adult Cardiologist & Heart failure specialist
Altamash general Hospital Clifton Block 1 Karachi
Email; hssbasadsoomro@gmail.com . Mobile 0302 2308718
“Malignancy begets Malignancy “
Chemotherapy cured cancer, at cost of
Heart Failure
ONCO – CARDIOLOGICAL &
CARDIO – ONCOLOGICAL
SYNDROMES
Dr Asadullah Khan Soomro
Adult Cardiologist & Heart failure specialist
Altamash general Hospital
Clifton Block 1 Karachi
Email; hssbasadsoomro@gmail.com .
Mobile 0302 2308718

2. “Cancer and
Cardiovascular disease
Two Medical Worlds Collide”
“ Lets not make curable disease incurable “

3. In 2021 around 20 million people were diagnosed with cancer
world wide.
Cancer in children is potentially curable in over 70% .
Thanks to revolutionary modern cancer treatment , but the worst
,a vivid memory , when we had to tell them that they are cured
from cancer but at the cost of Cardio-toxicity .
Many grownup cancer survivors ,especially females with ist
pregnancy ,when we have to tell them ,about pregnancy
associated cardio-toxicity . Sadly many can’t believe it but ,
bitter truth unfortunately .
Cancer & Cardio-toxicity
Introduction

4. Heart disease and cancer are top two causes of mortality all
over the world , 65% are living in lower /middle income
countries , it will rise to 75% in 2030.
Cardio-vascular complications of cancer therapy
( Iatrogenic epidemic) significantly contribute to the global
burden , and heart failure in particular is a relatively common
and life threatening complication.
It accounts for 46.1% of deaths world wide.
Cancer & Cardio-toxicity
Introduction

5. While contemporary cancer treatment truly represent a medical success
story ,because 5 year survival rates for all malignancies have increased
during the past 40 years , on the other hand this success has produced
a large population of cancer survivors with increase risk of chronic
multi - systemic diseases, one entity in particular ,chemotherapy
related cardiomyopathy ( CCMP ).
Cardio toxic effects of these crucial drugs are well described since 1970,
yet concrete strategies for screening ,prevention and management
of CCMP continue to be elusive owing to limited studies.
Cancer & Cardio-toxicity
Introduction

6. Late recognition of CCMP is associated with a poor prognosis
including lack of poor response to pharmacological therapy ,and end
stage heart failure.
Number of advanced HF therapies like CRTD ,LVAD,&
transplant are available ,however the role in CCMP is unclear.
In 2014 there were 14.5 million American cancer survivors and the
number is anticipated to reach 18 million in 2020.
In Europe 3 million patients are diagnosed with cancer each year ,
which means there is a large group at risk of treatment
- related complications.
Cancer & Cardio-toxicity
Introduction

8. Cancer Treatment & Your Heart
“ Protect Your Heart Before , During and Long After Cancer treatment “
Cancer treatments
Save Lives
But sometimes also can damage
your heart or blood vessels
HEART CONCERNS
After Treatment
Know what cancer treatment you have
had ,including dose and duration of
treatment.
Know your Risk Factors like blood
pressure
Ask about heart check up
Who are at more risk to
heart & vessels
• High blood pressure
• Diabetes
• Smoking /Tobacco
• Dislipidemia
• Obesity
Possible Effects during
treatment
• Damage to heart
or blood vessels
• Breathlessness,
weight Gain,
hypertension
Late Effects
Heart Problems can
develop late ,even
after 10 years .
Tell your physician team , if you
develop following symptoms
• Shortness of breath
• Irregular rapid heart beat
• Fatigue & Ankle Swelling
• Chest pain
WHAT YOU CAN
DO
Before & After
treatment
• Understand how cancer therapies ( Chemo & Radiotherapy) might
affect your heart :
• Discuss your Heart Health & Ask about , what increases the chances of harm
to your heart , Tests ( Echo ,BNP ) that could check how your heart or blood
vessels are doing & how to protect your heart during cancer treatment .
THROUGHOUT YOUR CANCER THERAPY JOURNEY
• Manage your blood pressure , diabetes & Weight
• Stop Smoking /Tobacco products & Illicit Drugs
• Daily Walk/Exercise
• Healthy Diet

9. Cancer Therapy Induced
Severe
Cardiac Toxicity
Cancer therapies ( Chemo & radiotherapy) are associated with cardio vascular Toxicity ,
especially Anthracyclines & trastuzumab
After Anthracycline Administration risk
of cardiac toxicity is around
7-65% ,
Depending on dose .
Mechanisms
Binding to topoisomerase 2-beta & cell death
Accelerated atherothrombosis
Coronary Spasm & cardiac dysrhythmias.
Severe Clinical Scenarios
Cardiogenic shock
Acute Heart Failure
Chronic advanced heart failure
Diagnosis : Transthoracic Echo , LV ejection fraction & strain, Cardiac MRI,
Biomarkers ( Troponin & Pro-BNP )
Cardioprotection :
ACE<ARB,ARNI, beta blockers & Spironolactone
Advanced Heart failure ( 3% of all advanced HF ) Heart transplant & LVAD .

10. Cancer Therapy Induced
Severe Cardiac Toxicity
ICU/CCU Admissions
Cancer therapy induced Cardiogenic Shock
Around 0.7 to 12% cancer patients are admitted to ICU as consequence of Cancer therapy .
Around 30% ICU resource utilization is from hematological malignancies.
Most frequent ICU admissions are due to infections , tumor lysis syndromes, acute major organ
injury , acute respiratory failure ,neurological and cardiac toxicity .
Cardiac Toxicity is not limited to anthracycline only but is associated with newer biological & Immunological
anticancer drugs and radiotherapy indeed.
Cardiac Toxicity can be classified into three main categories.
1) Acute cardiac toxicity caused by anthracyclines or 5 –FU 2) Takotsubo Syndrome 3) Acute on chronic HF due to CCMP .
Cancer Survivors
Increasing
Cardiac Toxicity
On Rise

11. In Patient
Cardio – Oncology
Service
Community
Cardio – Oncology
Service
Emergency
Cardio – Oncology
Service
OUT PATIENT
CARDIO – ONCOLOGY Service
RACOC
Rapid Access
Cardio – Oncology
Clinic
Nurse Led
Multi disciplinary
Clinic
Post Discharge
& Regular
Cardio – Oncology
Clinic
Cardio – oncology Rehabilitation
1
3 2
4
Soomro’s
Proposed Model of Cardio-oncology
Programme & Network

13. Cancer related cardio-toxicity ( Heart failure & Acute coronary
syndromes) has become a topic of growing concern ,and this
complex population presents unique challenges to cardio -
oncology community.
Early toxicity can limit a patient,s ability to complete effective cancer
therapy.
Late onset toxicity impacts cardiac mortality among cancer survivors.
Both symptomatic and asymptomatic forms of heart failure have
been reported ,which may be reversible or irreversible.
Conclusion

14. Overlaps in atypical symptomatology can make delineation between
asymptomatic LV dysfunction/ perserved systolic function and expected
side effects of chemotherapy bit difficult.
Additional barriers include a lack of a universal definition of
cardio-toxicity as well as the absence of established guidelines for
monitoring and survillance.
Certain biomarkers and novel imaging techniques are widely available but
their role in clinical practice is complex and controversial.
Conclusion

15. T

16. THANK You
Living Longer, Living Well