Breast cancer survivors, understand your heart health risks

Dr. Maya Guglin

Dr. Maya Guglin

Written by Dr. Maya Guglin a cardiologist at the UK Gill Heart & Vascular Institute.

Recently, the American Heart Association published a striking statement concerning women who have undergone chemotherapy and/or radiation treatment for breast cancer. The statement indicated that these therapies can contribute to heart failure or other heart problems, even years after the conclusion of cancer treatment.

If you are being treated for breast cancer or even if you are a survivor, this is undoubtedly a scary thought.

There is good news, however: Not all cancer treatment therapies can cause heart problems, and there are ways to potentially minimize your risk.

Which cancer therapies can cause heart damage?

Oncologists have long counseled patients about the risks associated with many life-saving cancer drugs. Two major classes of drugs linked to cardiac problems are anthracyclines and Herceptin (also known as trastuzumab). Their effects are very different.

Anthracyclines, including drugs like doxorubicin, can cause profound and long-lasting effects on cardiac muscles. These effects, however, are dose-dependent, and oncologists monitor the doses very carefully.

Herceptin typically causes milder cardiac damage, which is mostly reversible.

Additionally, radiation can cause arteries to narrow or develop blockages, which can lead to heart failure.

How can I minimize the risk to my heart?

Because of these side effects of cancer drugs, you probably had to have an echocardiogram – an ultrasound examination of the heart – to make sure your heart is healthy and can withstand the treatment.

Sometimes physicians may recommend altering therapy to avoid the possibility of heart damage. For example, instead of giving certain chemotherapies in one large dose, they may be less risky if given more slowly. And common cardiac medications like beta blockers may be able to reduce or prevent damage to the heart.

What should I do if I’ve had these treatments in the past?

The most important thing is to be aware of your risk for heart problems and to pay attention to your body. Fatigue, heart palpitations, shortness of breath and swelling are just a few symptoms of heart failure that are often overlooked.

Also, be sure you know the specific drugs you took for breast cancer. If you’re seeing a new doctor or coming into the emergency department, make sure your provider knows about your history with breast cancer treatment.

How can I reduce my risk of heart disease following breast cancer treatment?

Living a healthy lifestyle – managing your weight, eating well, exercising, and keeping an eye on your blood pressure and cholesterol – can help reduce your chances of developing heart problems.

Major research is currently underway regarding this particular problem. We hope that we can soon find ways to lessen or eliminate these potential risks to the heart from breast cancer therapies.

Next steps:

Dr. Ken Campbell

UK physiologist runs 5k for 1,000 straight days to support heart care

On Saturday, Aug. 26, a crowd gathered to watch Dr. Ken Campbell run his 1,000th 5k in as many days. About 20 people joined Dr. Campbell on his run to help celebrate his achievement.

Dr. Ken Campbell

Dr. Ken Campbell

Campbell, a UK physiologist and researcher, began his running streak on Dec. 1, 2014, and has run at least five kilometers each day since then. He has logged miles through days of work, travel and sickness. He has continued his streak on the UK campus, in his neighborhood in Lexington, and around the world, including Australia, Britain, Mexico and New Zealand. When there was no other option, he ran on a treadmill in the Johnson Center.

Raising money for patient groups and research

It all began as a way to raise awareness and funds for UK HealthCare’s ventricular assist device (VAD) and transplant support group and the Campbell Muscle Laboratory.

Through his research, Campbell has developed a relationship with Heart to Heart (the UK HealthCare Cardiothoracic Transplant/VAD Support Group), which offers support to patients and families of patients who have undergone a heart transplant or the implantation of a VAD. VADs are mechanical pumps that support blood flow in weakened hearts. Donations to Campbell’s cause benefit both the patient support group and student-driven research at the Campbell Muscle Lab.

Campbell’s running highlights the importance of the work he and his team are doing. His group at the Campbell Muscle Lab study the causes of cardiac failure, and his run streak will also help raise money for important research that benefits heart patients at UK.

Ending the amazing streak

After 1,000 days, Campbell is ending his run streak. He will no longer feel the need to rise at 3 a.m. on travel days or go out in the rain just to make sure he gets a run in.

“I’m really pleased at the turnout we had today,” he said after his run on Saturday. “We had this mixture of scientists and clinicians from all levels, from lab staff to the chief of Cardiovascular Medicine. We’re all coming together to push forward research and the care of our patients.”

Dr. Ken Campbell and his supporters

Dr. Ken Campbell and a group of supporters celebrate his 1,000th consecutive day running five kilometers.

Next steps:

When Lester Walters, a 59 year-old Berea native, had a heart attack, his journey to heart transplantation began. But he first required an artificial heart.

Mechanical heart keeps Berea man living, loving as he waits for transplant

Relaxing in a recliner in the corner of his ICU room, Lester Walters is all smiles. His red hair askew, he casually jokes with his wife and the nurses who come in regularly to check on him. The 59-year-old Berea native is waiting to be listed for a heart transplant, but he’s already one step ahead of most patients on the list – as of Dec. 12, 2016, Walters no longer has a failing heart.

Instead, a special machine has replaced it: the SynCardia temporary Total Artificial Heart, a battery-powered device that contains the same components as a real human heart and serves as a bridge to transplant.

“I feel great,” Walters said, the machine humming and pulsing like an air compressor in the background. “I feel about as good as one can.”

The first sign of heart problems

Walters’ journey toward a transplant began 17 years ago when he suffered a heart attack. Because he was adopted as a child, he had no knowledge of any heart-related medical history that may have been a risk factor. Doctors discovered Walters had atrial fibrillation, an irregular heartbeat that can cause poor blood flow. He had a pacemaker and an implantable cardioverter defibrillator (ICD) installed to “shock” his heart back into a regular rhythm if he experienced a life-threatening arrhythmia.

Walters resumed his normal lifestyle. He retired from Berea College in 2013 after 31 years of service and spent time taking care of his farm in Madison County. Seven years ago, the widower met his second wife, B.J. Pittman, and the two have spent their retirement fishing, raising chickens and gardening.

But by January 2015, his heart problems began to worsen. After a stint in another local hospital and a bacterial infection, he was referred to the UK Gill Heart Institute for more serious treatment. By the time he arrived, his body was swollen from edema – fluid retention caused by poor blood flow, where pressure in the blood vessels increases and fluid is forced from the vessels into body tissues.

Dr. Maya Guglin, medical director of UK’s Mechanical Circulatory Support Program, was the first to see Walters at UK. Her initial course of treatment focused on using medications to eliminate the swelling.

“We treated him with diuretics, beta blockers and other heart-failure medications,” Guglin said. “We managed to stabilize him for many months.”

Three shocks in a row

Then in early December 2016, Walters’ ICD went off once, then twice and then a third time a short while later, which knocked him unconscious. Although Walters had been shocked before – including one memorable time where his son caught him mid-fall and received a shock himself – he’d never experienced three shocks in a row.

Pittman rushed him to UK Chandler Hospital, where he was admitted. Walters had developed ventricular tachycardia (VT), a regular but very fast heart rate caused by improper electrical activity in the heart ventricles. The VT became incessant – a “VT storm,” as Guglin describes it – and his ICD ultimately shocked him 21 times over the course of a single day. Despite two alcohol ablations to attempt to kill off the misfiring heart cells, Walters’ heart was simply too damaged and scarred for the procedure to work.

He needed a heart transplant, but he was far too sick to survive one. The team placed Walters on ECMO, a treatment that provides support for patients with extreme cardiac and respiratory failure, to stabilize his condition.

Most patients with end-stage heart failure like Walters would then receive a left ventricular assist device (LVAD), a mechanical device that helps the heart pump blood throughout the body and allows the patient the chance to recover and gain back their strength. But in Walters’ case, the LVAD wasn’t enough.

“The LVAD was not an appropriate option in this case because of the VT,” said UK cardiothoracic transplant surgeon Dr. Alexis Shafii. “It could help his circulation, but it wouldn’t stop the electrical problem with his heart.”

The solution: Go ahead and remove the heart.

A bridge to transplant

On Dec. 13, Shafii performed the surgery to install the Total Artificial Heart in Walters, making him just the fourth patient at UK to receive the device as a bridge to transplant.

After the weeks of rapid deterioration leading up to his emergency hospital visit, Walters was blunt about his expectations going into surgery.

“I expected to die,” he said.

But the surgery went well.

“He immediately had a better color,” Pittman said.

From there, it was just a matter of time and work to regain his strength. Walters spent 10 weeks in the cardiovascular ICU, carefully monitored by Shafii and ICU staff. With the Total Artificial Heart keeping his heart rate at a steady 125 beats per minute for optimal blood flow, Walters soon began walking with the rolling power supply for his Total Artificial Heart, called the Companion 2 hospital driver, and an entourage of nurses in tow.

At first, he could only make it to the door of his room before needing to return to bed. But as the weeks went on, he worked his way up to twice-daily laps around the ICU.

“Starting out, it was really tough,” Walters said. “But I got to where I could walk a little more each day.”

Taking it ‘one day at a time’

In early February, he was stable enough to be switched to the Freedom portable driver, a smaller, wearable power supply for the Total Artificial Heart. The Freedom driver can be carried in a small backpack or shoulder bag and allows the patient to leave the hospital while they wait for a donor heart. Because of his progress, Walters was moved down to the cardiovascular telemetry unit, with hopes of being both listed for a transplant and discharged soon.

Dr. Navin Rajagopalan, medical director of heart transplantation at UK, notes that Walters’ steady improvement is a testament not only to his personal strength, but that of Pittman, who has been her husband’s rock through it all.

“Mr. Walters has made tremendous progress in the weeks following surgery,” Rajagopalan said. “It’s a testament to his strong determination and courage. But his wife has also been by his side every step of the way, providing encouragement and optimism, which has helped him in his recovery.”

And on this day, when the heart is on the minds of people across the country, Walters marks it as just another day in the journey that began with his initial heart attack 17 years ago. He and Pittman try not to think too far ahead, but focus on living in the present.

“I just take it one day at a time,” he said.

Media inquiries: Allison Perry, UK Public Relations,

See Lester Walters talk about his journey toward heart transplantation.

Next steps:

What is atrial fibrillation?

What is atrial fibrillation? Our expert Dr. Ted Wright explains.

In honor of Atrial Fibrillation Awareness Month, we sat down with the UK Gill Heart & Vascular Institute’s Dr. Ted Wright to discuss the condition, how it’s treated and what you can do if you have it.

Watch our conversation with Dr. Wright below.

Atrial fibrillation, also known as AFib, is a type of irregular heartbeat. If left untreated, it can increase a person’s risk for stroke and heart failure.

Dr. Ted Wright

Dr. Ted Wright

Dr. Wright is a heart surgeon at the UK Gill Heart & Vascular Institute. He is UK’s leading expert in atrial fibrillation treatment and is the only doctor in the region performing the Mini-MAZE procedure, a surgical treatment for people with the condition.

Check out the first video in our interview series below where Dr. Wright explains what AFib is and how it’s diagnosed. Be on the lookout for more highlights from our conversation with Dr. Wright in the coming days.

Next steps:

  • The UK Gill Heart & Vascular Institute is a leader in diagnosing and treating abnormal heart rhythms, including AFib. Learn more about Gill’s Heart Rhythm Program.
  • Check out our Q&A with Dr. Wright about heart disease and African-Americans.
Jim Lester was in end-stage heart failure, but a doctor from the same hometown helped him to trust in a heart procedure that eventually saved his life.

Hometown connection leads to life-saving heart procedure

Jim Lester encourages others to listen to his heart. As you adjust the stethoscope’s earpieces and lean in, you hear an electronic whir and zing reminiscent of a video game. The sound that startles others makes Lester laugh. Apparently this is not the first time he’s unleashed this parlor trick.

Just two weeks prior, Lester was gravely ill, in end-stage heart failure, the result of a lifetime of repeated heart attacks (three), blood clots (four) and a stroke. His ejection fraction – a measure of the heart’s ability to pump blood – was less than 20 percent. A healthy person’s EF sits in the 50 to 70 percent range.

Lester remembers the conversation with Alexis Shafii, his physician at the Gill Heart Institute. “Dr. Shafii was straight to the point,” Lester remembers. “He said that I had to have an LVAD in order to survive.”

A left ventricular assist device, or LVAD, is a mechanical device that helps a weakened heart pump blood. “An LVAD doesn’t replace the heart,” said Dr. Maya Guglin, medical director of Mechanical Circulatory Support at the UK Gill Heart Institute. “It just helps it do its job.” However, Guglin was cautious. Implanting an LVAD requires open heart surgery and a lifetime of maintenance. It’s not a good fit for every patient.

A common connection

Lester was afraid of surgery. He kept asking whether there were any pills that could help him instead of this strange-looking machine. Then he met Sarah Branam, one of the three LVAD coordinators at the Gill.

“The team asked me to do some education with Jim, since he was very standoffish about the idea of having an LVAD,” Branam said. “I started discussing with him what his fears were with the LVAD, I just wanted to help relieve his concerns. And I always say, ‘Where are you from?’ and when he said, ‘Maysville, Kentucky,’ I was like, ‘Well, funny thing, so am I!'”

They bonded instantly. Lester knew Branam’s “Papaw,” Clarence Branam, and then knew he could trust Sarah. She understood Lester’s fear of the unknown, but she could also share her experiences with many patients with LVADs.

“I got to see patients go from being in the ICU, and being as sick as they are, to see them with quality of life: the stamina, no oxygen tank, being able to walk farther, getting back to what they wanted to do… it was just amazing,” Branam explained.

“I was awful scared, but after talking to Sarah and finding out she comes from Maysville, why, everything leveled out,” Lester said tearfully. “This little thing came in, and she would answer any questions I had, and took all my fears away.”

Even better: Lester qualified for a clinical trial to implant a new version of an LVAD called HeartMate 3.

The power of advanced medicine through clinical trials

According to Guglin, the HeartMate 3 is a tremendous improvement from its predecessor with a longer battery life, smaller profile and engineering that minimizes the potential for complications like blood clots and GI bleeds.

“That the Gill was included in this major clinical trial was a coup for us,” Guglin said. “It’s a signal that the cardiology world recognizes our expertise, our professionalism and our teamwork.”

And, Guglin adds, this also helps fulfill the heart institute’s academic mission, since high-profile trials like that for the HeartMate 3 expose Gill trainees to the newest available technology – technology that could become standard treatment by the time they are in their own practice.

On Aug. 8, Lester was implanted with the HeartMate 3. Everyone noticed immediately how improved he was.

“The biggest thing I saw about Jim before the surgery was how hard he was struggling to breathe. And the day after the breathing tube was pulled out, he did not need supplemental oxygen,” Branam said.

“It felt like I was getting too much oxygen,” Lester laughs.

A new lease on life

After a couple of weeks of recovery and therapy, Lester was discharged. What will he do with this new lease on life?

“Well, I aim to go home, sit on my front porch, watch the traffic go up and down the street, and hug my wife,” Lester said.

Lester was the Gill’s first HeartMate 3 patient, but three others followed within 10 days. This phase of the trial is now closed, but the UK will be involved in the next phase, a “Continued Access Protocol” that permits all qualifying patients to receive the HeartMate 3 while FDA approval is pending.

Based on her initial involvement with the HeartMate 3 trial, Guglin has great hopes for the device.

“It’s an amazing feeling when you come to see the patient next morning after the surgery and their skin color is different and there is life in them,” she said. “And when they are being discharged 10 days or two weeks later it’s gratifying to see how much they improved on your watch because of the intervention you were able to offer.”

Next Steps