consultation 🌟

The Heart of the Matter: Assessment and Clearance

Six days of cardiac testing and anxiety. From coronary calcification concerns to discovering excellent heart function. The relief of receiving clearance to proceed with the preferred chemotherapy regimen.

The Heart of the Matter: Assessment and Clearance

November 23rd - 29th, 2025. Six days that felt like six weeks. Six days of cardiac testing, waiting, and wondering: would my heart let me fight this cancer with the best weapons available?

Meeting Dr. Lyon (By Phone)

November 23rd, 2025 - 10:40 AM

Remote phone consultation with Dr. Alexander Lyon, Consultant Cardiac Oncologist at Royal Brompton Hospital.

Even over the phone, you could tell: this is someone who knows his stuff. Cardio-oncology is a subspecialty - doctors who specialize in managing heart health in cancer patients. Exactly what I needed.

Taking the History

Dr. Lyon went through everything:

The cardiac murmur:

  • Found 20+ years ago after a fall (A&E visit)
  • Told I had a murmur
  • Had an ECG
  • But never had an echocardiogram (heart ultrasound)
  • Just lived with it - asymptomatic except very rare palpitations
  • No problems during two pregnancies

The cholesterol story:

  • Fifteen years ago: cholesterol over 11 (normal is under 5)
  • That’s not just high - that’s “probable familial hypercholesterolaemia” territory
  • Started statins at some point
  • Stopped for some reason (couldn’t remember why)
  • Never restarted (life got in the way, moved house, follow-up lost)

Risk factors - the good and the bad:

Good (Protective):

  • Lifelong non-smoker ✓
  • No hypertension ✓
  • Active lifestyle ✓
  • Healthy weight ✓

Bad (Concerning):

  • Very high cholesterol (likely genetic)
  • Coronary calcification on PET/CT
  • Never properly investigated or treated

The connection: The coronary calcification on my cancer scan isn’t surprising - it’s the consequence of 15+ years of untreated high cholesterol depositing in my arteries.

Immediate Action: Start Treatment

Dr. Lyon didn’t wait.

“Start Atorvastatin 20mg tonight, increase to 40mg in a week.”

Why Atorvastatin 40mg specifically?

  1. Treats the high cholesterol (long overdue)
  2. Research suggests it may offer cardioprotection against Epirubicin toxicity

So it’s doing double duty - managing the cholesterol problem and potentially protecting my heart during chemotherapy.

Potential side effects discussed:

  • Muscle aches (1 in 10-20 people)
  • Memory/sleep issues (1 in 100-200 people)
  • Rare: muscle breakdown or liver problems (1 in 5,000-10,000)

Safety monitoring: Blood tests in 4 weeks to check muscle enzymes and liver function.

The Testing Plan

Dr. Lyon ordered a comprehensive cardiac workup, to be done this week:

  1. Blood tests - Cardiac biomarkers, cholesterol panel, general health markers
  2. ECG - Baseline heart rhythm and electrical activity
  3. Echocardiogram - Heart ultrasound to assess function and structure
  4. CT Coronary Angiogram - Detailed imaging of the coronary arteries
  5. Carotid Doppler Ultrasound - Check carotid arteries for disease

Goal: Get complete picture of cardiovascular health to determine if anthracycline chemotherapy is safe.

The Week of Testing

November 23rd - 28th, 2025

Appointments at various clinics. Blood draws. Scans. Lying in machines. Holding still. Holding breath. Waiting.

What I Knew:

  • These tests would determine which chemotherapy regimen I’d get
  • Preferred regimen (EC) is cardiotoxic
  • Alternative regimen (TCHP) is safer for heart but harder on quality of life
  • Dr. Parton wanted to give me EC if my heart could handle it

What I Didn’t Know:

  • Would they find significant blockages?
  • Would my heart function be compromised?
  • Would the cardiac murmur turn out to be a problem?
  • Would they say “too risky” and force the second-choice treatment?

The Anxiety:

It’s a strange feeling - hoping your heart is healthy enough to tolerate toxic chemotherapy. Hoping the poison meant to kill cancer won’t kill your heart in the process.

The Waiting:

Between tests and results. Between appointment and phone call. Between question and answer.

Every day of delay is another day the cancer sits there. I know it’s being careful. I know it’s the right thing. But it feels like time slipping away.

The Results Call - November 29th

Second remote phone consultation with Dr. Lyon. This time, he had all the results.

Alex and I both on the call. Hearts in throats. (Pun somewhat intended.)

The Cholesterol Panel

Current levels:

  • Total cholesterol: 6.2 (still elevated)
  • LDL (“bad” cholesterol): 4.2 (high)
  • HDL (“good” cholesterol): 1.1 (normal)
  • Triglycerides: 1.9 (normal)
  • Lipoprotein(a): Normal

Historical records obtained from GP:

  • 2009: Cholesterol 11, triglycerides 10 (both very high)
  • Started Simvastatin 40mg
  • Developed abnormal liver function tests
  • Stopped Simvastatin (that’s why I stopped!)
  • Was supposed to switch to Atorvastatin
  • Never happened (I moved, follow-up lost)

Now it all makes sense. I didn’t just stop statins randomly - I had a side effect. But the follow-up to try a different statin got lost in life transitions.

Plan: Continue Atorvastatin 40mg lifelong. May need additional medication (PCSK9 inhibitor) after cancer treatment if cholesterol remains high.

The ECG

Heart rhythm:

  • Sinus rhythm at 93 bpm (normal)
  • Two ventricular ectopic beats (extra heartbeats - common, usually benign)
  • Left axis deviation (variant of normal)
  • All intervals normal (PR, QRS, QTc)

Translation: Normal ECG with occasional extra beats. The palpitations I occasionally feel are real but not dangerous.

The CT Coronary Angiogram

This was the big one. Detailed look at the coronary arteries.

What they found:

  • Non-obstructive coronary atheroma (cholesterol plaques) in:
    • Left main stem
    • Proximal left anterior descending artery (LAD)
    • Second diagonal artery
    • Right coronary artery

Coronary calcium score: 247

That sounds scary. And yes, it confirms I have coronary artery disease.

But here’s the critical part: “No flow-limiting stenoses”

The plaques are there. The calcium is there. But the arteries aren’t significantly blocked. Blood is flowing freely to the heart muscle.

It’s like having some rust in the pipes, but the water still flows fine.

The Echocardiogram

This was the moment.

Left Ventricular Ejection Fraction (LVEF): 71%

Normal is above 55%. Mine is 71%.

Global Longitudinal Strain (GLS): -24.9%

Normal is less than -18% (it’s a negative number - more negative is better). Mine is -24.9%.

NT-proBNP: 19 pg/ml

Normal is under 125. Mine is 19.

Translation: My heart is pumping beautifully. No wall motion abnormalities. No valve disease. No hypertrophy. Normal-sized atria. Everything is working exactly as it should.

The cardiac murmur? Likely just benign flow-related sounds. Nothing structurally wrong.

The Result: Despite having coronary artery disease (the calcium and plaques), my heart muscle is strong and healthy with excellent function.

The Clearance

Dr. Lyon’s assessment:

“Patient is fit to start EC chemotherapy.”

Those words. The relief.

Why It’s Safe:

  1. Excellent baseline cardiac function - LVEF 71% gives plenty of cardiac reserve
  2. Coronary disease is non-obstructive - blood flow not compromised
  3. Atorvastatin provides cardioprotection - both for cholesterol and potentially against chemotherapy
  4. Close monitoring plan - will catch any problems early

The Monitoring Plan:

After first 2 cycles of EC (4-5 weeks):

  • Repeat echocardiogram
  • Repeat ECG
  • Repeat cardiac blood tests

Purpose: Check for any cardiac effects from Epirubicin. Measure any change in heart function. Adjust treatment if needed.

Safety net: If heart function starts to decline, they can modify treatment. But with baseline function this good, there’s plenty of room for safety.

Managing the Ectopy (Extra Heartbeats):

Key: Keep potassium and magnesium levels normal during chemotherapy. These electrolytes stabilize heart rhythm.

If palpitations become troublesome:

  • Can start low-dose Carvedilol (beta-blocker)
  • 3.125mg twice daily, increase to 6.25mg if needed
  • Only if symptoms problematic

Other Recommendations:

  • Continue Atorvastatin 40mg daily (lifelong)
  • High-dose Vitamin D for 6 weeks (level was mildly low at 40)
  • Maintain electrolyte balance during chemo (K+, Mg2+)

What This Means

We got the green light for the preferred treatment regimen.

Not the cardiac-sparing alternative with more neuropathy and diarrhea.

The EC followed by Taxol plus Phesgo regimen - the one with the best pCR rates, the one Dr. Parton wanted to give if my heart could handle it.

My heart can handle it.

Yes, I have coronary artery disease. Yes, I need lifelong cholesterol management. Yes, I’ll need cardiac monitoring during treatment.

But my heart function is excellent, and with close surveillance, EC chemotherapy is safe.

This gives me the best shot at pCR.

The Emotional Journey

November 23rd: Anxiety. What will they find?

November 23rd-28th: Limbo. Testing, waiting, not knowing.

November 29th: Relief. Pure, overwhelming relief.

The coronary disease is real. The calcium score is real. But they’re manageable. They don’t disqualify me from the best treatment option.

It’s strange to be relieved that you’re healthy enough to tolerate toxic chemotherapy. But that’s where we are.

The Bigger Picture:

This cardiac detour, while stressful, may have saved my life in the long run.

Without the PET/CT for cancer staging:

  • Wouldn’t have known about coronary calcification
  • Wouldn’t have quantified the coronary disease
  • Wouldn’t have started statins
  • Could have had a heart attack down the line

The cancer scan found a heart problem. The cancer treatment plan led to comprehensive cardiac evaluation. The cardiac evaluation found disease that needed treatment.

Silver lining: Now I’m on appropriate heart medications, I know my baseline function, and I’ll have close cardiac monitoring during chemotherapy.

Ready to Fight

Cardiac assessment: Complete ✓
Cardiac clearance: Received ✓
Treatment regimen: EC → Taxol + Phesgo (preferred option) ✓
Monitoring plan: Established ✓
Heart protection: Atorvastatin 40mg started ✓

Next step: Back to oncology. Sign consent forms. Finalize treatment start date.

Target: December 12th, 2025

The cardiac pause is over. The path is clear.

Time to fight this cancer with the best tools available, knowing my heart is strong enough for the battle ahead.

Date: 23-29 November 2025
Cardiologist: Dr. Alexander Lyon, Royal Brompton Hospital
Key Finding: Excellent cardiac function (LVEF 71%) despite coronary disease
Decision: CLEARED for EC chemotherapy
Result: Preferred treatment regimen approved
Bonus: Cardiovascular disease identified and treatment initiated
Status: Ready to begin cancer treatment