8/6/20: Cardio-Oncology Appointment

I was anxious going into this appointment, though I don't know exactly why. I had already figured that whatever the cardio-oncologist said, I'd be okay with it, even if she recommended stopping Herceptin, or taking medication.

In the exam room, a nurse did a quick EKG. She also took my blood pressure and remarked that it was high.

For a few months now, sometimes when I've gotten my vitals taken before treatment, my blood pressure has been a little high. Not consistently, but it used to fluctuate among the green, yellow, and orange zones of the table on this page, and now it fluctuates among the yellow, orange, and lighter red zones. By chance, at my recent PCP appointment, my blood pressure was perfectly in the green zone, so high blood pressure wasn't something we discussed. 

Incidentally, my blood work from the PCP appointment also came back showing high cholesterol. This blog is all about my cancer, so I didn't think it was relevant, but at today's appointment, the cardio-oncologist asked about both my blood pressure and cholesterol. Of course they are both related to heart health, which is now being affected by Herceptin. I also did some Googling, and it turns out that there's a connection between menopause and high blood pressure, and also between menopause and high cholesterol. It's difficult to identify a direct cause, but since I do have hormone therapy to thank for chemically-induced menopause, maybe they are cancer-related after all. I'll have to work harder at exercising and eating well.

Anyway, the cardio-oncologist asked me a lot of questions. I don't think I have any symptoms of heart failure. She listened to my heart, which sounded normal. In the end, she didn't think there was anything to be concerned about. Phew! I can finish my Herceptin treatments. 

She said she doesn't usually worry until the ejection fraction gets to 50%, and also that the ejection fraction isn't an exact measurement, so there's wiggle room. 

She also mentioned another measurement that is not always reported on echocardiograms, I think she called it the strain. She said she would follow up with the cardiologist who authored my echocardiogram report to see if they could provide this measurement. If it turns out to be problematic, she would consider putting me on some kind of medication. If the measurement is not available, then we'd proceed assuming it's fine. 

Basically there is no action to be taken at this point, but she assured me that she usually acts aggressively to protect the heart, especially for someone my age. I did find that reassuring, because it means my case really must not be very troubling.

I'll have a follow-up echocardiogram and appointment in a few months, after I'm finished with Herceptin. In the meantime, she recommended I keep an eye on my blood pressure using a home monitor, and maybe even send her some data (a couple measurements over a few days) through the online patient portal.