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Care During Chemotherapy and Beyond

Cardiovascular Events

What Are Cardiovascular Events?

Cardiovascular events refer to any incidents that may cause damage to the heart muscle.

The heart is a busy organ, constantly pumping blood filled with oxygen and nutrients through your arteries, into the heart muscle (myocardium). Any interruption of blood flow will lead to an injury, or infarction. This is called a heart attack, or a myocardial infarction (MI). This is also known as a coronary or cardiovascular event.

Causes of Cardiovascular Events:

  • Arrhythmias
  • Heart valve disease
  • Cardiomyopathy (enlarged heart)
  • Certain types of cancers (malignancies), and drugs that are used to treat them, may cause blood clots, or a thrombosis, in your legs, heart, or in your lungs.
  • Carotid or coronary artery disease
  • Chest pain that starts in the chest, and spread to the throat, jaw, shoulder blades, or arms (left or right), may be a sign of a coronary event
  • You may experience a feeling of chest heaviness, or tightness.
  • You may have nausea, sweating, or dizziness associated with your chest pain. It may also cause you to feel short of breath.
  • Chest pain may spread to the stomach, and feel like indigestion.

Symptoms:

If you are having a cardiovascular event, you may experience many symptoms. These may include:

  • You may be overly tired, or very weak (fatigued). It may be hard for you to do any kind of your normal activities.
  • You may have coughing spells or a long-term (chronic) cough, if your cardiotoxicity results in a certain type of heart failure (such as congestive heart failure).
  • You may experience sudden or gradual shortness of breath, either at rest or while performing any type of activity. This may include walking to the door, or climbing stairs.
  • If you have gradual shortness of breath, you may have trouble lying flat in bed, and you may have to sleep on 2 or more pillows. Your shortness of breath may cause you to wake up in the middle of the night.
  • Your legs may be swollen, especially in your feet and ankles. You may gain "water" weight easily, or feel bloated.
  • You may feel anxious, or "stressed out." You may feel your heart pounding in your chest or throat, which may cause pain or mild discomfort. You may also feel your heart fluttering, and it may seem as if it is skipping a beat.
  • Some people may have chest pain in addition to palpitations, sweating, or feelings of impending doom. The chest pain may range from excruciating, to a mild discomfort. The severity of pain does not indicate how severe the damage to the heart muscle may be. If you experience chest pain with your palpitations, seek emergency help immediately.

Things You Can Do:

  • If you think you are having a cardiovascular event, such as a blood clot in the heart or lungs, a heart attack, or irregular heart beats, it is important to seek emergency assistance immediately. Damage to the heart muscle can be decreased if you act quickly. It is better to be safe.
  • Severe shortness of breath needs to be evaluated by a healthcare provider. Do not wait for it to improve, especially if you are having shortness of breath at rest.
  • You may be experiencing chest pain. Not all forms of chest pain are life threatening, but it is important that you have your chest pain evaluated by a healthcare provider. The goal of chest pain is to relieve the cause.
  • If your chest pain is due to musculoskeletal problems, such as muscle strain, there is most likely an area you can locate that is causing most of the pain. Anti-inflammatory drugs (such as ibuprofen), along with a local application of heat, for no more than 20 minutes at a time, 3 or 4 times a day, may help.
  • If you have chest pain due to lung problems, such as pneumonia or pleurisy, your doctor may prescribe antibiotics to treat the condition. You may also have to be hospitalized, depending on how severe your problems are.
  • If you have chest pain due to anemia, your healthcare provider may order a blood transfusion, depending on your symptoms.
  • If your chest pain is due to coronary artery spasm, you may be prescribe drugs to control your discomfort. These include nitrates, such as nitroglycerin, to increase blood flow to the heart, and decrease the work of the heart by dilating (expanding) the arteries. 
  • There are many ways to treat chest pain. Again, it is important to have your pain evaluated by a professional 
  • Keep a diary of your irregular heart rate, chest pain or palpitations, if they are occurring regularly. Write down the foods that you have eaten, the exercise or activity you were undergoing when the symptoms occurred, and how you felt before they occurred. This diary may be valuable in determining the cause of your irregular heart rate, chest pain or palpitations.
  • Questions to ask yourself, may include:
    • Did my symptoms occur gradually, or did this episode come on all of a sudden? Was I feeling anxious? Did I perform any kind of activity, or was I resting?
  • Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies). 
  • Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease.
  • If you have a family history of heart disease, stroke, high blood cholesterol, or high blood pressure, in a first or second-degree relative, you may be at risk for certain problems. Notify your healthcare provider if you have any of these diseases in your family.
  • If you are experiencing heart failure, you may be told to reduce the amount of salt you are eating in a day. Many times, it may be restricted to about 2 grams of sodium per day. You should discuss this with your healthcare provider how you can specifically use your diet to control your symptoms of heart failure.
  • You should try to exercise, as tolerated, to maintain your optimal level of functioning. Discuss with your healthcare provider how you can create a specific exercise program to suit your needs.
  • You should restrict the amount of alcohol you take in, or avoid it all together. Alcohol may adversely interact with many medications.
  • If you are ordered a medication to treat this disorder, do not stop taking any medication unless your healthcare provider tells you to. Take the medication exactly as directed. Do not share your pills with anyone.
  • If you miss a dose of your medication, discuss with your healthcare provider what you should do.
  • If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
  • Keep all your appointments for your treatments.

Medications That May Be Prescribed By Your Doctor:

  • ACE inhibitors - These drugs work by opening, or dilating, your arteries. They will lower your blood pressure, and improve blood flow to your kidneys, and through out your body. Your healthcare provider may also prescribe these medications if you have diabetes or protein in your urine, to protect your kidneys. Some examples of this medication may include: enalapril maleate (Vasotec®), lisinopril (Zestril®), and fosinopril sodium (Monopril®)
  • Antianxiety medications: If your symptoms are due to anxiety, your healthcare provider may prescribe an Anti-anxiety medication, called an anxiolytic.  These medications will help you to relax. These may include lorazepam (Ativan®), or alprazolam (Xanax®). It is important to take these medications only when you are feeling anxious. Do not operate heavy machinery, or drive an automobile while taking these. If these medications do not control your symptoms, discuss this with your doctor.
  • Anticoagulants - These medications prevent your blood from clotting. Each of them works in a variety of ways. Depending on your overall health status, the kind of chemotherapy you are receiving, and the location of the blood clot, your healthcare provider may suggest warfarin sodium (Coumadin®), or enaxoparin (Lovenox®).
  • Aspirin - Depending on your overall health status, and the type and severity of your arrhythmia, your healthcare provider may prescribe aspirin as a "blood thinner." Aspirin works by preventing platelets in your blood from forming blood clots (anti-platelet).
  • Beta-blockers - can be used to slow down your heart rate, and improve blood flow through your body. You may take this drug if you have been diagnosed with irregular heartbeats, palpitations, thyroid problems, heart failure or high blood pressure. Some examples of this medication may include: metoprolol (Lopressor®), propranolol (Inderal®), and atenolol (Tenormin®).
  • Calcium Channel Blockers - These medications may be given to treat chest pain, high blood pressure, or irregular heart beats. A few common drugs include Verapamil HCL (Calan®), and Diltiazem (Dilacor XR®).
  • Diuretics - may be known as "water pills" as they work to prevent heart failure by making you urinate out extra fluid. Some examples of this medication may include furosemide (Lasix®), and Hydrochlorthiazide. You may receive this medication alone or in combination with other medications.
  • Digoxin - Also called digitalis, this medication works by slowing down the heart rate, and making it beat more effectively. This will pump blood through out the body better. It is also called Lanoxin®.
  • Vasodilators -are drugs that work by opening up or "dilating" the vessels. These may include isosorbide dinitrate, or Isordil®.
  • Do not stop any of these medications abruptly, as serious side effects may occur

When to Contact Your Doctor or Health Care Provider:

  • Fever of 100.5° F (38° C), chills, sore throat (possible signs of infection).
  • Sudden or gradual shortness of breath, chest pain or discomfort; swelling of your lips or throat should be evaluated immediately
  • If you feel your heart beat rapidly (palpitations), and have not noticed this before
  • Any new rashes on your skin, especially if you have recently changed medications
  • Any unusual swelling in your feet and legs
  • Weight gain of greater than 3 to 5 pounds in 1 week.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

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