CLL and heart failure

[Judami]

I am a 78 year old female. I was diagnosed with CLL in 2012, was on w&w until 2015, then had 4 rounds of chemotherapy. I have been on Imbruvica since 2020. Recently I had a ECT at my yearly physical and it was abnormal. The ECT I had in 2019 was normal. I had a heart ultrasound which shows that I have left bundle branch block and a ef of 40%. Has anyone else experienced this? Could this be caused by Imbruvica? I am not on any other medication. I’m am having so much anxiety. Does this mean heart failure? I am going for a stress test Oct 4.

[lindalou5]

I have Afib and enlargement of ventrical that occurred after being on Ib and then acal. Is now under control with some heart meds and so far working fairly well. Had absolutely no heart issues prior to CLL meds. Can't say that is the same for you, but it definitely was my issue. The heart meds have enabled me to stay on the acal.

[CLLquilt in reply to lindalou5]

Did you have any symptoms that you could share? How did you find out you had afib? Thanks in advance!

[lindalou5 in reply to CLLquilt]

For about two weeks I had weird feelings in chest. I had PVC's many years ago but had not had any issues with that for many years since. I thought it may be that coming back cause I was really stressed. Since I have long history of Anxiety disorder, I kind of blame everything on my nerves until it continues or gets really bad. I finally called a nurse and she told me to go to Urgent care within two hours. Went there and they did electro-card, and they called ambulance to take me to hospital. So spent a week there and they took me off my acal, and put me on flecainide. (that is another story-in my bio) Took about four days to start regulating the beats. Had many other tests on the heart done..so diagnosis was Afib and enlarged left ventrical. That was three years ago and so far doing good with the medication.

[CLLquilt in reply to lindalou5]

Thank you!

[lindalou5 in reply to CLLquilt]

just another little bit of experience from my father's CLL journey. He lived for abt 30 years without any treatments. He died at age 79 of heart failure. But he had 30 some years with rather healthy and active living. His mother-my grandma-lived with CLL in her eighties and died age 89. Uncle with CLL for a bit over decade-no treatment died age 79 of heart failure. But he was an alcoholic and smoked like a steam engine for years.

[Artlover1908]

I had a heart attack while on w&w, and that's 4 years ago. It's kept under control by meds and I've been on acalabrutinib for nearly 2 years. No problems since . Hope it works out as well for you.

[NYCBill]

Judami—I can’t comment on the particulars of your heart condition, of course, in any informed or intelligent way. But I can say I underwent heart failure while on treatment four years ago (on a trial, none of your exact medications). My heart was fine before that. I believe, my own belief supported only by common sense and an extra cardiologist opinion, is cll does weaken one’s overall system, leave you more vulnerable to trouble you might fight off without cll. … in my own case, it was a confluence of events—family stress, not sleeping for weeks, back pain, a very hot summer that caused me to overhydrate and dangerously dilute my salts, plus cll and the cll meds. I got tachycardia, spent a long time in the hospital. … Long and short, my oncologist would say cll wasn’t involved ( in a purely linear fashion) but common sense suggests it made me vulnerable. I am not noted for common sense, however, and your situation differs from mine. So take it with a big grain of salt. I did learn finding a cause for these things is complicated. Best. Bill

[AnnieZ102]

I got pneumonia in 2018, and that was when I discovered I had right bundle block dysfunction. No connection with CLL was made at the time. I subsequently completed six months of chemotherapy, which was successful. I've had a few ECGs more recently for other health issues and it's never been mentioned. I don't expect it disappeared! I'm almost 76 now.

[julius_the_cat]

Perhaps your annual physical included an ECG (rather than ECT) which would have detected a left bundle branch block. The echo would show the left ventricular ejection fraction (EF). Normal EF is 50% or greater; it is never 100% and a typical value is 60-65%.

EF of 40% is mildly reduced. The stress test is looking for coronary artery cholesterol blockages as a possible cause. For you, the test is best performed with a medication (sometimes with a slow walk) instead of higher intensity exercise .

Reduced EF has been reported with Ibruvica (ibrutinib) and can be treated heart medications but usually they're used when the EF is < 40%. Sometimes Ibruvica is stopped or switched to an alternative for CLL but not always - this is for you & your doctor to discuss, of course.

Heart failure generally refers to symptoms - not sure if you have any. A blood test called BNP can check for heart congestion or heart failure.

A cardiologist or even better a cardio-oncologist may be helpful in the future. These are general comments & may not specifically apply to you. Hope this helps some.

[IAMSUEBW]

I pray you don't have afib. I was diagnosed in 2012 and had chemo twice a week for 6 mos. This went well until 2016 when I started with issues again. I went on Imbruvica 2016 until it stopped working 2022. Tried Calquence, tried Brukinsa and finally went on one-year treatment of Gazyva (6mos) starting Venclaxta after 22 days continuing full dose for remainder of full year. I didn't have issues with chemo in 2012 but was very tired. I wish you well.