After the cancer had come back and I knew that I had Stage IV melanoma, it was a stressful time. However, I was determined to continue to fight the disease.
***My oncologist and I had started looking at clinical trials for the right fit for where I was in the disease process.***
I wanted to try one of the vaccine trials because, after much reading and careful consideration, I thought that particular path looked the most promising for me.
At the same time I began to notice that it was getting harder for me to catch my breath after almost any significant physical exertion.
***Even briskly walking to a meeting in another part of the hospital would sometimes leave me gasping for air.***
Then, we took a family trip to Charleston, South Carolina. My daughter and a group she was in were performing at the Spoleto Festival. So, we went to hear some music, eat some really good food and again see the sights of Charleston. While there, I began to notice that I couldn’t walk 10 feet without running out of breath. I started volunteering to push my new grandson in the stroller to help me make it as we walked around town. I suppose it sort of helped my like my heavy duty walker does today.
When I got back home, I went to my primary care doctor who scheduled me for a stress test. During the stress test, I became very short of breath just like in Charleston and gasped for air for several minutes after the test had ended. No chest pain in any of these events – just shortness of breath.
***The cardiologist advised me that, if convenient, he thought we should do an angiogram (hearth cath) to check things out and that he thought it might be urgent that we do it.***
So, I called my wife to come to the hospital and I was taken to the Cath Lab holding area for prep. Since I had not eaten breakfast prior to the stress test, I was ready to go. There was significant blockage and the cardiologist placed a stent to keep the vessel open.
Coronary artery disease occurs when atherosclerotic plaque (hardening of the arteries) builds up in the wall of the arteries that supply the heart. This plaque is primarily made of cholesterol. Plaque accumulation can be accelerated by smoking, high blood pressure, elevated cholesterol, and diabetes. Patients are also at higher risk for plaque development if they are older (greater than 45 years for men and 55 years for women), or if they have a family history of early heart artery disease. Okay, I admit that I was in several risk categories.
The atherosclerotic process causes significant narrowing in one or more coronary arteries. When coronary arteries narrow more than 50% to 70%, the blood supply beyond the plaque is not enough to meet the increased oxygen demand during exercise. The heart muscle in the area of these arteries becomes starved of oxygen (ischemic). Patients often experience chest pain (angina) when the blood oxygen supply cannot keep up with demand.
***Up to 25% of patients experience no chest pain at all, despite a lack of adequate blood and oxygen supply. These patients have “silent” angina, and have the same risk of heart attack as those with angina. I did not feel any chest pain, only shortness of breath.***
I was more worried about a possible metastasis to the lung than heart problems. The blockage in my vessel was greater than 80% so there was no wonder that I was suffering from frequent and repeated attacked of breathlessness.
When a blood clot (thrombus) forms on top of this plaque, the artery becomes completely blocked, causing a heart attack.
***I evidently missed the heart attack by only a very short period of time. I felt then as I do now that someone (God) was watching over me because I still had a purpose for living.***
Now the question entered my mind as to whether the cancer could have had anything to do with the heart disease. The quick answer I received at the time, was a resounding no. But as my symptoms and disease process would progress over the next couple of years, I would question again whether or not there could be some connection.
***A wide variety of systemic diseases may affect the heart by a number of different mechanisms, including increasing demands on the heart, causing arrhythmias, affecting the structure of the heart or promoting cardiovascular disease and therefore ischemic heart disease.***
As for malignant disease (cancer), the metastatic spread of malignancy to the heart is far more common than primary cardiac tumors. The most common clinical presentation is from pericardial effusion, tachyarrhythmia, atrioventricular (A/V) block, and congestive heart failure. The question of A/V block would arise for me about four years later. And again, there would be differing medical opinions on how close the relationship was between that problem and my cancer.
***Tumors most likely to metastasize to the heart are malignant melanoma, leukemia, malignant germ cell tumors and malignant thymoma.***
By reading about the fact that some 75% of melanoma patients that are autopsied show cardiac metastases, you can see were my concern about connections would arise.
Although cancer of the lung and breast do not often metastasize to the heart, because of the very high numbers, they account for the greatest numbers of cardiac metastases. Lung cancer can also cause atrial fibrillation in the absence of metastatic spread to the heart.
Also, cancer can trigger paraneoplastic syndromes that in many respects mimic other autoimmune diseases.
***For example, the most prevalent autoimmune related disorder, diabetes mellitus (Type I Diabetes), can cause coronary artery disease, cardiomyopathy, and congestive heart failure. Almost all Type I Diabetes patients carry anti-GAD antibodies. I would much later discover that I too carried anti-GAD antibodies although not diagnosed with diabetes.***
Perhaps there could be a connection between what other disease process that the cancer triggers and at least some kind of acceleration of coronary artery disease?
In addition, it is well documented that a number of other multi-system autoimmune related disorders can cause heart problems:
- Rheumatoid arthritis can cause pericarditis, pericardial effusion, coronary arthritis, myocarditis, and valvulitis. In fact, a number of inflammatory rheumatologic disorders appear to have a strong relationship with the occurrence of heart disease.
- Seronegative arthropathies can cause aortitis, aortic and mitral insufficiency, and conduction abnormalities.
- Systemic lupus erythematosus (SLE) can cause pericarditis, endocardits, myocarditis, and thrombosis (arterial and venous). My daughter has lupus and, like me, has suffered a pulmonary embolism. I will further discuss clotting disorders in a later part of my story in fighting my melanoma.
- Amyloidosis can cause heart failure, restrictive cardiomyopathy, valvular regurgitation, and pericardial effusion.
- Sarcoidosis can cause heart failure, dilated or restrictive cardiomyopathy, ventricular arrhythmias, and heart block.
- Marfan’s syndrome can cause aortic aneurysm and dissection, aortic insufficiency, and mitral valve prolapse.
***So, while perhaps coincidental in my event or perhaps not so coincidental, cancer can directly and indirectly result in significant heart related issues, particularly in a long term fight.***
The worst part of my heart disease was the fact that I could not participate in any of the clinical trials that my oncologist and I had chosen.
***Because I had heart disease, I was in an “excluded category” for every clinical trial we asked.***
We finally abandoned our effort and focused on seeing where the cancer would go from here. From posting around the web, I have since learned that this is a problem for a lot of advanced cancer patients who want and need to participate in clinical trials – exclusion because of heart disease.