Radiation Heart Disease

What is radiation heart disease?

Radiation therapy is a common treatment for people with cancer. Radiation treatment uses beams of energy to destroy cancer cells. If you receive radiation therapy to your chest, it can damage your heart.

Radiation heart disease describes a range of heart problems that occur due to radiation therapy. These problems can develop weeks or years after receiving radiation therapy.

Radiation heart disease occurs most often in people who receive treatment for:

• Breast cancer.
• Esophageal cancer.
• Hodgkin lymphoma.
• Lung cancer.

How does radiation therapy affect the heart?

Radiation can injure the tissues in and around your heart. Short-term, this can cause inflammation. Over time, these tissues may become tough and fibrous, and unable to function properly.

The heart tissues most often affected by radiation therapy include the:

• Arteries that carry blood to your heart muscle (coronary arteries).
• Cells that produce and carry electrical impulses that maintain your heart rate and rhythm (conduction system).
• Heart muscle (myocardium).
• Tissue that covers your heart (pericardium).
• Valves that separate the chambers of your heart and prevent blood from flowing backward.

The main short-term side effects occur in the pericardium (tissue around the heart). These include pericarditis and pericardial effusion. These conditions generally occur weeks to months after radiation therapy. They’re more common in people who have undergone treatment for Hodgkin lymphoma.

Longer-term complications may not show up for years, sometimes up to 20 years. These heart conditions include:

• Congestive heart failure.
• Coronary artery disease.
• Enlarged heart (cardiomyopathy).
• Heart rhythm changes (arrhythmia).
• Thickening of the pericardium (constrictive pericarditis).
• Valvular heart disease.

Who is at risk of heart disease after radiation treatment?

You could be at risk of heart disease after receiving radiation to your chest, especially your left side, which houses your heart. The unit of measurement for radiation is called a Gray (Gy). A total dose of more than about 30 Gy over a series of radiation treatments increases your risk of radiation heart disease.

Other factors that increase your risk for radiation-induced heart disease include:

• Cotreatment with cardiotoxic chemotherapy medications, such as trastuzumab or anthracyclines.
• Pre-existing heart disease.
• Younger age during radiation treatment.

Health conditions and behaviors can also increase your risk of radiation heart disease. These include:

• Carrying excess weight.
• Diabetes.
• Excess alcohol use.
• High blood pressure.
• Physical inactivity.
• Smoking.
• Unhealthy cholesterol levels.

How common is radiation heart disease?

As researchers recognized the risk of cardiotoxicity many years ago, experts have developed newer and safer technologies that minimize radiation to your heart. As a result, fewer people are developing radiation heart disease.

What causes radiation heart disease?

Radiation therapy for treating cancers in your chest can cause radiation heart disease. The radiation destroys cancer cells but can also damage nearby heart tissues.

What are the symptoms of radiation heart disease?

Symptoms of radiation heart disease vary by how soon they appear and the type of heart condition the radiation has caused.

Short-term radiation heart disease

Short-term side effects of radiation therapy include pericarditis and pericardial effusion. The main sign of both conditions is severe chest pain that:

• Improves when you sit up and lean forward.
• Worsens when you breathe deeply.

You may also experience shortness of breath (dyspnea) that improves when you bend over.

Long-term radiation heart disease

Radiation heart disease may not cause any symptoms until it progresses. Your symptoms will depend on the type of heart condition you have. In general, the signs of heart disease include:

• Chest pain or discomfort.
• Dizziness or fainting (syncope).
• Dry cough.
• Nausea.
• Rapid or irregular heartbeats (palpitations).
• Shortness of breath.
• Swelling of your ankles, legs, feet or abdomen (edema).
• Weakness or fatigue.

Severe radiation heart disease can also lead to a deadly heart attack or cardiac arrest.

Heart attack and cardiac arrest are life-threatening emergencies. If you suspect you or someone you’re with is experiencing a heart attack or cardiac arrest, don’t hesitate to call 911 (or your local emergency services phone number). Time is critical, and a delay of even a few minutes can result in permanent damage or death.

How is radiation heart disease diagnosed?

Healthcare providers use many types of tests to diagnose radiation heart disease. The types of tests used depend on your symptoms and medical history. In addition to a physical exam and blood tests, your provider may order one or more of these tests:

• Cardiac catheterization.
• Cardiac CT scan.
• Cardiac MRI.
• Chest X-ray.
• Echocardiogram.
• Electrocardiogram (EKG or ECG).
• Electrophysiology test.
• Exercise stress test.
• Holter monitor.
• Endomyocardial (heart) biopsy.

How is radiation heart disease treated?

Treatments for heart disease range from lifestyle changes and medications to minimally invasive and surgical treatments. Your provider will work with you to determine the right treatment approach for you.

Advances in heart disease treatment are helping people live longer with better quality of life.

How do newer technologies reduce radiation heart disease?

The main strategy for preventing radiation heart disease is limiting the amount of radiation your heart receives.

Advanced cancer radiation technologies deliver precise doses of radiation to the tumor and reduce the amount of radiation the surrounding tissues receive. These include:

• Intensity-modulated radiation therapy (IMRT): Uses 3D tumor mapping and highly controlled beams of radiation.
• Proton therapy: Uses high-energy, positively charged particles called protons and deposits nearly all its energy directly into the tumor.

Positioning can also help reduce radiation exposure to your heart during breast cancer treatment. For example, you may receive treatment while lying on your stomach or in short bursts when you take a deep breath.

How can I reduce my risk of radiation heart disease?

If you’ve received chest radiation, you can lower your risk of developing heart disease by leading a heart-healthy lifestyle. This includes:

• Avoiding alcohol.
• Eating a healthy diet.
• Exercising regularly.
• Managing your blood pressure and cholesterol levels.
• Quitting smoking.

Routine follow-up care after you complete cancer treatment is also essential to monitor your overall health. Your provider may order routine tests every five to 10 years to check your heart function.

What is the outlook for people treated with radiation therapy?

As more people are surviving cancer and living longer, knowledge about the long-term effects of treatment is expanding. The risk of developing heart disease increases the longer you live after cancer treatment. But technologies that reduce radiation exposure to the heart are lowering this risk.

Your individual outlook depends on:

• The amount of radiation your heart received.
• Your age when you received radiation.
• Your cardiovascular risk factors, including diet, exercise and underlying health conditions.

When should I talk to a healthcare provider?

Call your healthcare provider right away if you experience any symptoms of heart disease. These include chest pain or discomfort, shortness of breath or an irregular heartbeat.

Seek emergency care right away if you suspect you may be experiencing a heart attack or cardiac arrest.

A note from Cleveland Clinic

People who received cancer radiation therapy to their chest can develop radiation-induced heart disease years later. But recent advances in radiation technology mean fewer people are developing heart disease from the effects of radiation. Heart disease treatment options are also improving and allow for better quality of life. Let your healthcare provider know if you’ve received radiation therapy in the past and if you experience any symptoms of heart disease.