Cardio-oncology

Heart care, planned around cancer treatment.

Cardio-oncology looks after the heart before, during, and after cancer therapy. Dr. Subash Chandhar T served as consultant cardiologist and onco-cardiologist at Cancer Institute (WIA), Adyar from 2021 to 2026, and continues this work in Chennai.

ExperienceOnco-cardiologist, Cancer Institute (WIA), Adyar, 2021–2026
FocusBefore, during, and after cancer therapy
Working principleProtect the heart, keep treatment on track

Some cancer treatments can affect the heart. Cardio-oncology is the part of cardiology that manages that overlap: assessing heart risk before therapy starts, watching for early warning signs during treatment, and looking after the heart in the years that follow. The aim is almost never to stop cancer treatment. It is to make the treatment plan safely possible.

When a cardiology review helps

Before treatmentBaseline assessment

Heart history, examination, ECG, and echocardiography before therapy that can affect the heart, with blood pressure, diabetes, and cholesterol brought under control early.

During treatmentSurveillance and symptoms

Scheduled echo reviews during higher-risk therapy, and prompt assessment of new breathlessness, chest discomfort, palpitations, swelling, or falling effort tolerance.

After treatmentRecovery and follow-up

Review of heart function once therapy ends, and a clear plan for how long cardiac follow-up should continue based on the treatment received.

Long-term survivorsLate effects

Some effects appear years later, particularly after radiotherapy near the heart or higher cumulative chemotherapy doses. New symptoms in a survivor deserve a low threshold for review.

Treatments that can involve the heart

The risk is specific to the treatment and to the patient. Anthracycline chemotherapy, HER2-targeted therapy, some newer targeted and immune therapies, and radiotherapy fields near the heart are the common reasons an oncology team asks for cardiac review. Dose, drug combinations, age, and existing heart disease all change the picture, which is why the assessment is individual rather than a checklist.

Heart disease that already exists at the time of a cancer diagnosis matters just as much. A patient with prior stenting, weak heart function, or valve disease may need their cardiac plan adjusted so that surgery, chemotherapy, or radiotherapy can proceed on schedule.

What a consultation involves

The visit brings the cancer story and the heart story together: the treatment plan or treatment history, symptoms, examination, ECG, and echocardiography, with transesophageal or contrast echo, stress testing, Holter, or ambulatory blood pressure monitoring when they genuinely add information. It ends with a written opinion the oncology team can act on: fit to proceed, proceed with protection and monitoring, or treat the heart first.

Working with the oncology team

Five years at a dedicated cancer hospital shape how this clinic works. Decisions are made with the treating oncologist, not around them, reports go back in language that supports the treatment timeline, and interrupting cancer therapy is treated as a last resort rather than a reflex.

During cancer treatment, severe chest pain, sudden breathlessness, fainting, or a racing irregular heartbeat needs emergency care first, not a routine appointment. Go to the nearest emergency department, call local emergency services, or reach the Venkataeswara Hospitals emergency department on 044 4511 1111, which is staffed around the clock.
Common questions

Questions patients and families ask.

Why did my oncologist send me to a cardiologist? Is something wrong?

Often nothing new is wrong. A cardiology review is frequently part of planning rather than a sign of a problem. Your oncology team wants a record of how the heart is working now, so that treatment can be chosen with that in mind, and so any change later can be compared against a starting point. Sometimes the referral is prompted by a symptom, an abnormal test, or a heart condition you already have. Ask your oncology team which reason applies to you, and mention any breathlessness, chest discomfort, palpitations, or swelling at the visit.

Will this heart check delay the start of my chemotherapy?

Usually not. The assessment is planned so that the treatment timeline can continue, and a written opinion goes back to the oncology team. History, examination, ECG, and echocardiography can often be done at one appointment. If further tests such as a Holter monitor, stress testing, or a transesophageal echo are needed, they may be arranged separately. Booking early, as soon as a review is advised, leaves the most time before the planned start date. If a heart problem does need treatment first, your cardiologist and oncologist will decide the safest order together.

Does the heart scan hurt? Will there be needles?

The usual tests are painless. An ECG uses stickers on the chest and takes only a few minutes. An echocardiogram is an ultrasound scan done with gel and a probe on the chest, with no injection and no radiation. Some situations call for a contrast echo, which needs a small injection into a vein, or a transesophageal echo, where a thin probe is passed into the food pipe. For that test the throat is usually numbed with a spray, sedation is commonly used, and the throat can feel sore for a short time afterwards. If either is planned you will be told in advance, along with any preparation such as fasting.

What happens if my heart scan comes back abnormal?

An abnormal scan does not automatically mean cancer treatment stops. Often a change is picked up before any symptoms appear, and treatment continues with closer monitoring and, in some cases, heart medicines. Sometimes the safest course is to treat the heart first. That decision is made with your oncology team, and it depends on your scan, your symptoms, and the treatment planned. An emergency is different. Severe chest pain, sudden breathlessness, fainting, or a racing irregular heartbeat needs emergency care first, not a routine appointment. Go to the nearest emergency department or call local emergency services.

If I develop a symptom between visits, do I call my oncologist or the cardiologist?

For anything related to your cancer treatment, contact your oncology team first, since they know your current cycle and can involve the cardiologist. For heart symptoms that are new but not severe, such as gradually worsening breathlessness, ankle swelling, or palpitations, tell both teams and ask for a cardiology review. For severe chest pain, sudden breathlessness, fainting, or collapse, do not telephone anyone first. Go to the nearest emergency department or call local emergency services.

Will I need heart tests for the rest of my life?

Not always, and the plan is individual. How long follow-up continues depends on which drugs and doses you received, whether radiotherapy passed near the heart, whether heart function changed during treatment, and other risk factors such as blood pressure, diabetes, and cholesterol. For some people a review once therapy ends is enough. Others are advised to continue periodic checks, because certain effects can appear years later. Follow the plan your cardiologist and oncology team give you rather than stopping checks on your own. It also helps to mention your cancer treatment to any doctor you see in future, even many years later.

These answers are general information and cannot replace a consultation. If symptoms feel urgent, go to an emergency department or call local emergency services.