Many people are not aware that cancer patients may also require special heart monitoring during their treatment. Some cancer therapies such as chemotherapy, targeted therapy, and radiation therapy can affect the function of the heart and blood vessels. Therefore, in certain cases, patients may need a cardiologist who has specific expertise in managing cardiovascular conditions in cancer patients.
This field is known as cardio-oncology, a subspecialty focused on the prevention, monitoring, and management of heart complications that may arise during or after cancer therapy. This approach aims to ensure that cancer patients can continue their treatment optimally without neglecting their heart health.
At Mandaya Royal Hospital Puri, this service is provided by dr. Siti Elkana Nauli, Sp.JP (K), a consultant cardiologist with expertise in cardio-oncology. She plays an important role in helping monitor and manage the risk of heart disorders in patients who are undergoing or planning to undergo cancer therapy.
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Getting to Know dr. Siti Nauli, a Cardiologist Specialized in Cardio-Oncology
dr. Siti Elkana Nauli, Sp.JP (K) is a consultant cardiologist with experience in diagnosing and treating various cardiovascular diseases. She completed her medical degree at the University of Indonesia and continued her cardiology specialist training at the same institution. To further deepen her expertise in cardiac imaging, dr. Siti also completed the Fellow of Echocardiography program at the University of Indonesia.
In the professional field, dr. Siti actively contributes to several cardiology organizations. She is a member of the Indonesian Heart Association and the Indonesian Society of Echocardiography, and is involved in the Pulmonary Hypertension Working Group and the Indonesian Heart Failure and Cardiometabolic Working Group. In addition, she is a Fellow of the Heart Failure Association – European Society of Cardiology, and serves as a board member of the Asian Society of Cardiology and the World Heart Failure Society.
In her clinical practice at Mandaya Royal Hospital Puri, dr. Siti provides comprehensive heart examinations and treatments. Available services include Cardiac MRI, Cardiac CT, Cardiac Nuclear imaging, coronary angiography, and various procedures in the Cath Lab. She also performs supporting examinations such as echocardiography, electrocardiogram (ECG), stress tests, and Ambulatory Blood Pressure Monitoring (ABPM).
In addition, dr. Siti offers comprehensive cardiology consultations, including procedures such as cardioversion and electrophysiology studies to assist in diagnosing and treating heart rhythm disorders.
dr. Siti Elkana Nauli, Sp.JP (K) is available at Mandaya Royal Hospital Puri on the following schedule:
- Monday: 16.30 – 18.30 WIB
- Wednesday: 16.30 – 18.30 WIB.
Why Cancer Patients Need Monitoring by a Cardio-Oncology Cardiologist
Several types of cancer therapy can cause side effects on the heart, known as cardiotoxicity. This condition occurs when cancer treatment causes damage to the structure or function of the heart.
These effects may appear during treatment or sometime after therapy has been completed. In patients who already have a history of heart disease, this condition may even worsen pre-existing heart problems.
Below are several types of cancer treatments and their potential effects on heart health:
1. Chemotherapy
One therapy that may affect heart health is chemotherapy. Chemotherapy drugs work by destroying rapidly growing cells, including cancer cells. However, in some cases, these drugs may also affect healthy cells, including heart cells. Certain chemotherapy drugs are known to trigger heart rhythm disorders, inflammation of heart tissue, reduced heart function, and even heart failure.
2. Immunotherapy
In addition to chemotherapy, immunotherapy, which works by stimulating the immune system to fight cancer cells, can also affect the heart in some patients. In certain cases, this therapy may lead to reduced heart pumping ability, high blood pressure, and inflammation of the heart muscle.
3. Radiotherapy
Radiotherapy or radiation therapy may also affect the heart, especially if the radiation area is located around the chest. Radiation exposure can cause inflammation and the formation of scar tissue in the heart, which over time may interfere with heart function.
For these reasons, monitoring by a cardiologist who specializes in cardio-oncology is very important for cancer patients. With proper monitoring, the risk of heart disorders can be detected earlier so that treatment can be provided promptly without disrupting the cancer treatment process.
Heart Disorders That May Occur Due to Cardiotoxicity
Cancer therapies such as chemotherapy, immunotherapy, and radiotherapy can sometimes cause heart-related side effects known as cardiotoxicity. This condition may trigger several cardiovascular problems, including:
1. Heart rhythm disorders (arrhythmia)
Arrhythmia is a condition in which the heart rhythm becomes abnormal. The heart may beat too fast, too slow, or irregularly. This disorder can originate from the upper chambers of the heart (atria) or the lower chambers (ventricles).
2. High blood pressure (hypertension)
Hypertension occurs when blood pressure remains consistently above normal levels. This condition can increase the risk of various heart diseases, including heart attack and stroke.
3. Coronary artery disease
Coronary artery disease occurs when the coronary arteries that supply blood to the heart become narrowed or blocked. This narrowing is usually caused by plaque buildup on the artery walls, which reduces blood flow to the heart muscle.
4. Heart failure
Heart failure occurs when the heart cannot pump blood effectively throughout the body. This condition may occur if the heart muscle becomes weakened, thickened, or stiff, preventing it from functioning optimally.
5. Myocarditis and pericarditis
Both conditions involve inflammation of the heart. Myocarditis is inflammation of the heart muscle, while pericarditis is inflammation of the protective lining surrounding the heart.
6. Cardiomyopathy
Cardiomyopathy is a disease that causes changes in the structure or function of the heart muscle. These changes can make it more difficult for the heart to pump blood throughout the body.
7. Pericardial effusion
Pericardial effusion is the accumulation of fluid around the heart. If too much fluid accumulates, it can interfere with the heart’s ability to pump blood normally.
Heart Examination Services for Cancer Patients at Mandaya Royal Hospital Puri
Mandaya Royal Hospital Puri provides various examinations to monitor heart health in cancer patients undergoing chemotherapy. These examinations aim to detect heart disorders early so that treatment can be initiated as soon as possible.
1. Electrocardiogram (ECG)
An electrocardiogram is a test used to record the electrical activity of the heart. In this procedure, small electrodes are placed on the chest, arms, and legs and connected to an ECG machine. The device records the heart’s electrical signals so doctors can evaluate whether any heart rhythm abnormalities are present.
2. Blood tests
Blood tests can also help detect possible heart damage. Doctors usually examine certain markers such as cardiac troponin (cTn) and natriuretic peptide (NP). The levels of these proteins may increase when damage occurs in heart cells. Blood tests may also include evaluation of cholesterol levels and diabetes screening.
3. Echocardiography
Echocardiography is a heart examination that uses sound waves or ultrasound to produce real-time images of the heart. This test helps doctors assess the condition of the heart chambers, heart valves, and the heart’s ability to pump blood.
4. Cardiac Magnetic Resonance Imaging (MRI)
Cardiac MRI uses magnetic fields and radio waves to produce highly detailed three-dimensional images of the heart. This examination provides information about heart structure, pumping function, and possible changes in heart tissue.
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