Heart Health: Kids with Cancer
What To Expect in Long-Term Heart Health Follow-up: Part 2
Heart health: In a previous post, we discussed the potential negative cardiac side effects of specific cancer treatments. We also touched briefly on the importance of long-term follow-up to help monitor for these effects.
In this post, we will take a closer look at the types of heart evaluations performed as part of long-term follow-up.
Physical Exam
The most important aspect of follow-up after cancer treatment is regular doctor office visits. Your care team will help connect you to a specially-trained provider who can follow cancer patients throughout life. This consistent follow-up helps the provider notice any changes that may take place after treatment, even years down the road.
Key to these follow-up visits is the physical exam. First, the doctor will check vital signs and interview the patient about symptoms or concerns. Then they will use their eyes, ears, and hands to inspect the patient’s body for abnormalities.
Based on the exam, the doctor may recommend further testing to gain more detailed information.
What Kind of Tests Can I Expect?
EKG (Electrocardiogram)
An EKG (or ECG) is a simple test that measures the electrical activity in the heart. An EKG is a painless procedure and takes around five minutes to complete.
During the test, a nurse will attach twelve leads (electrodes) to various parts of a patient’s body using stick-on patches. Each lead measures the heart’s electrical activity from a different angle. The leads then transmit this data back to a special computer that produces a graph of the heart rhythm over about ten seconds.
The EKG provides your doctor with important information about the heart rate and rhythm. It can also indicate damage to the heart muscle or certain changes in the heart’s structure.
Echocardiogram
An Echocardiogram (or Echo) is a type of ultrasound (sonogram) that uses sound waves to measure heart structure and function. An Echo usually takes 30 to 60 minutes to complete.
During an Echo, a trained technician will squirt a type of gel onto the patient’s chest. This helps transmit sound waves more clearly. The tech will then slide a probe, called a transducer, across the surface of the chest in various directions.
The transducer produces sound waves that travel through the chest and bounce off different heart structures and back to the transducer. The pattern of sound reflection creates a type of video that shows the heart’s structure and function.
There are several things your provider can learn from an Echo. They may use an Echo to determine if the heart’s valves are functioning properly. The test will also show if the heart is contracting and relaxing in a healthy way, and how much blood pumps out with each heartbeat. An Echo can reveal if there is abnormal fluid in or around the heart (effusion).
Stress Test for Heart Health
A Stress Test is a type of test used to monitor the body’s response to exercise. The entire procedure, including preparation and recovery, usually takes about an hour. The test itself lasts about 10 minutes.
During a stress test, a patient’s EKG, symptoms, and vital signs (blood pressure, heart rate, oxygen levels) are monitored while they perform vigorous exercise. This exercise involves walking/running on a treadmill or riding a stationary bike. A specialized team will closely supervise the exercise for safety.
Some patients are unable to physically exercise due to disability or a medical condition. In this case, they may be given a medicine through an IV that simulates the body’s response to exercise.
The data collected during a stress test will tell your doctor if heart muscle damage has occurred. It can also provide clues that heart problems are likely to occur in the future, even if none have yet happened.
MRI/CT
Two types of tests doctors sometimes use in heart evaluation are Magnetic Resonance Imaging (MRI) and Computed Tomography (CT). These help to identify changes to the heart muscle and heart valves, inflammation, scarring, and blood flow through the heart’s blood vessels.
MRI
An MRI uses strong magnets and radio waves to scan a patient’s body and produce detailed computer images of the patient’s anatomy. No X-rays are used in MRIs. In some cases, doctors may order a type of IV dye (contrast) to make images clearer.
During an MRI, the patient lies down on a table that is then slid into a tube slightly wider than the body and surrounded by magnets. There is a speaker inside the tube, and the technician may use this to give the patient instructions, such as holding their breath for a few seconds. The test usually lasts 60-90 minutes.
The patient may hear loud clanking noises during the test as magnets shift inside the machine. An MRI is not painful, but some patients who feel uncomfortable in enclosed spaces may not tolerate the test well.
Because of the strong magnets, it can be dangerous for patients with metal implants to have an MRI. In this case, providers will recommend alternative tests.
CT Scan
A CT scan (sometimes called a CAT scan) also renders detailed computer images of body structures, but it produces these pictures using X-rays and radio waves. IV contrast is sometimes used in CT scans as well, especially when doctors want to see blood vessels more clearly.
For a CT scan, a patient lies on a table that passes through a large donut-shaped scanner. A CT scan usually causes no discomfort and is completed in about 30 minutes.
Because a CT scan involves radiation exposure, providers may recommend other tests before ordering a CT.
Heart Monitor
If symptoms or test results raise the suspicion of arrhythmias, the doctor may ask the patient to wear an ambulatory heart monitor (telemetry).
Similar to an EKG, a heart monitor collects data about the heartbeat through leads attached to various points on the body with stickers. The leads transmit this data back to a small monitoring unit that records and stores it for review by the physician.
Unlike an EKG, a heart monitor collects data over a longer period of time, from 24 hours to as long as 30 days, depending on the situation. This allows the patient to go about their day-to-day life with the heart monitor in place, so the doctor can get a sense of the heart rhythm during regular activity.
Lab Tests
Some treatments and health conditions require periodic lab work to monitor for organ function, drug levels, and treatment effectiveness. This usually involves collecting a urine sample or using a needle to draw a small amount of blood from a vein in the arm.
Lab tests may take anywhere from minutes to weeks to result.
What If Test Results Are Abnormal?
Your primary doctor can manage some abnormal results. They may start new medication, adjust existing medication, or recommend lifestyle changes such as diet or exercise. They may also request that you keep a log of blood pressure, heart rate, or blood sugar.
If test results indicate a need for further cardiac testing or treatment, your doctor may refer you to a cardiologist, a doctor who specializes in heart health care.
Timeline (Heart Health)
Because some changes can occur without early symptoms, the patient needs to continue this regular follow-up as long as recommended, even if they do not feel sick.
In Part 2 of this series on long-term cardiac follow-up, we will discuss which schedules for follow-up are recommended for different types of cancer treatment.
References
Cleveland Clinic. (2022, May 9). MRI (magnetic resonance imaging): What it is & results. Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/4876-magnetic-resonanChildren’s Oncology Group. (2023, October). Keeping your heart healthy (Health Link, Version 6.0). https://survivorshipguidelines.org/pdf/2023/English%20Health%20Links%20V6%20Secured/22_Heart_Health_v6%20(secured).pdf
Children’s Oncology Group. (2023, October). Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers (Version 6.0). https://survivorshipguidelines.org/pdf/2025/COG_LTFU_Guidelines_Only_v6.pdf
Children’s Oncology Group. (2023, October). Introduction to long-term follow-up after cancer treatment (Health Link, Version 6.0). https://survivorshipguidelines.org/pdf/2023/English%20Health%20Links%20V6%20Secured/26_Intro_to_LTFU_v6%20(secured).pdf
Hendrick Health. (n.d.). Chemical stress test. Hendrick Health. https://www.hendrickhealth.org/services/radiology-diagnostic-imaging/chemical-stress-test/
Mayo Clinic. (2024, May 7). CT scan. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/ct-scan/about/pac-20393675
Mayo Clinic. (2025, January 7). Stress test. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/stress-test/about/pac-20385234
PDQ Pediatric Treatment Editorial Board. (2025, February 12). PDQ late effects of treatment for childhood cancer. National Cancer Institute. https://www.cancer.gov/types/childhood-cancers/late-effects-pdq
Seattle Children’s Hospital. (n.d.). Echocardiogram. Seattle Children’s Hospital. https://www.seattlechildrens.org/clinics/heart/what-to-expect/echocardiogram/
