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How do you monitor for HER2 cardiotoxicity?

Most cancer centers perform routine monitoring of heart function during treatment with HER2-targeted therapies. The method used for monitoring and the frequency of tests depends on each case. Imaging of the heart will take place before therapy begins to ensure a normal heart function and will be repeated every three months after the HER2-targeted agent is started. Over time, you may have the test done less often, and no monitoring is required after therapy is completed. The risk of cardiotoxicity is greatest during HER2-targeted therapies and lower once these cancer treatments are stopped. More testing may be done if you develop symptoms that suggest heart failure.

What are signs and symptoms of HER2 cardiotoxicity?

In most cases of cardiotoxicity from HER2-targeted therapies, a decline in heart function will be found during routine monitoring with the patient having no symptoms or vague symptoms, such as fatigue. In some cases, however, the decrease in heart function will be accompanied by symptoms of heart failure.

In heart failure, the heart isn't pumping as well as it should, which leads to fluid buildup in the lungs and eventually in the legs. Patients may experience:

  • Shortness of breath, especially with exertion.
  • Swelling of the ankles, legs and sometimes abdomen.
  • Chest pressure or shortness of breath when lying flat.
  • Waking up with severe shortness of breath.
  • Rapid changes in weight.
  • Heart palpitations.
  • Extreme fatigue.
  • Decreased appetite.
  • Nausea.

If you develop any of these symptoms, talk to your doctor at once.

How do you prevent HER2 cardiotoxicity?

In addition to controlling your cardiac risk factors, a few studies have suggested certain medications may help prevent cardiotoxicity from HER2-targeted therapies. These include angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs) and beta blockers. Most providers will not routinely start these medications for this purpose if there is no history of heart disease or heart risk factors. More research is needed and is currently in progress. However, if you already have heart disease, you may benefit from being on one or more of these medicines when you receive HER2-targeted therapy. 

How do you treat HER2 cardiotoxicity?

Cardiotoxicity from HER2-targeted therapies tends to be temporary and reversible. For most patients, their heart function will return to normal.

If your heart function significantly declines, as detected by routine tests or because of symptoms, your physician may start you on cardioprotective medications (ACE inhibitors, ARBs, and/or BBs) to help your heart recover. 

If your heart function declines to an ejection fraction <40%, your physician may recommend you stop HER2-targeted therapies for a short time. Typically, therapy is put on hold for about four weeks, and then tests are repeated. In most cases, the heart function returns to normal, and HER2-targeted therapy can start again with close monitoring.

If the heart function does not return to normal, your provider may recommend you stop the medication completely. However, this type of decision is made on an individual basis and in close consultation with your team of health providers, including your oncologist and cardiologist or cardio-oncologist, paired with a careful discussion of what you prefer and value.

  • Last Edited 01/22/2025