Side Effect: Heart Attack

What is a heart attack?

A heart attack, also known as a myocardial infarction (MI), occurs when blood flow to a section of the heart muscle is blocked, resulting in the death of the affected tissue. This blockage is usually caused by a clot that forms in a coronary artery, which supplies blood to the heart muscle. An MI may be “silent” and go undetected, or it could be a catastrophic event leading to irreversible damage or death.

The blood vessel blockage may be complete or partial:

• Complete blockage: ST-elevation myocardial infarction (STEMI)
• Partial blockage: Non-ST-elevation myocardial infarction (NSTEMI)

What does a heart attack look like?

Symptoms of an MI can vary in intensity and duration. Symptoms may not be the same for everyone. It is important to note that some people may experience a heart attack without ever having symptoms. Symptoms of an MI may include:

• Chest pain or discomfort, sometimes this can radiate to the neck, jaw, shoulder, or arm
• Shortness of breath
• Nausea or vomiting
• Cold sweat
• Lightheadedness

Diagnostic tests and procedures such as an electrocardiogram (ECG or EKG), cardiac troponins, and echocardiogram (ECHO) may be done to help your healthcare team determine the type of MI that occurred and how much of the heart muscle was damaged from the MI.

Who gets heart attacks?

Patients with cancer are at a higher risk of developing an MI due to chemotherapy, targeted therapies, and chest radiation leading to coronary artery damage. Other risk factors for developing an MI include:

• Smoking
• High cholesterol, or dyslipidemia
• Diabetes
• High blood pressure, or hypertension
• Obesity
• Sedentary lifestyle
• Peripheral vascular disease
• Trauma
• Vasculitis
• Drug use (cocaine)
• Abnormal coronary artery
• Aortic dissection
• Excess demand on the heart muscle

How do you prevent heart attacks?

Preventing an MI in patients with cancer involves managing cardiovascular risk factors, such as high blood pressure, high cholesterol, smoking cessation, maintaining a healthy weight, exercising regularly, and monitoring for potential cardiac side effects of cancer treatment.

How do you treat heart attacks?

Treatment for an MI in patients with cancer is similar to treatment for patients without cancer. Acute management of an MI may include:

• Anti-platelet medications: aspirin, clopidogrel (Plavix®), prasugrel (Effient®), ticagrelor (Brilinta®)
• Nitrates: nitroglycerin (Nitrostat®)
• Beta-blockers: metoprolol (Toprol XL®, Lopressor ®), carvedilol (Coreg®)

In some cases, procedures such as coronary artery bypass grafting (CABG) or opening clogged coronaries arteries (percutaneous coronary intervention, or PCI) may be necessary.