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Blood Clot in right atrium!! Very nervous, worried :(
Should I be so worried about a large blood clot in the right atrium of my heart? In January 2014 I was diagnosed with stage 3, Her 2 Positive - ERPR Negative Infiltrating Ductal Breast Cancer. A port was installed so I can receive the Chemo treatments. I have completed all of the treatments except for the one drug named Herceptin. I have to receive this drug until February of 2015. I have to complete one year on the Herceptin, which ends in February 2015. In May I had a double Mastectomy and they removed 24 lymph nodes and 5 of them were full of cancer.
I am 57 years old. My Oncology Doctor does not want to deal with this issue at all, she referred me to a heart doctor. The clot was first discovered in July of 2014 but for some reason I was not told by my Oncologist until the end of October. At that time I was prescribed Coumadin 10 mg. the first day and 5 mg. every day thereafter. Within seven days my blood draws showed I was around 700. The normal range is 200 to 300. It took over a week to get the level to come down. I was then put on two and a half mg. per day. I had a blood draw and again it was still too high. So now I am on 1 mg. per day and it is too low. So the doctor informed me that it could take me some time to get to the correct therapeutic level.
Today the heart doctor ordered another Echo Heart Scan. He showed me the clot and said it was large and was against the wall of the right atrium, and the end of the port is pressed against the clot. He now wants me to go in the hospital and he said they would go down my throat with a camera and get better pictures of the clot. When the Oncologist ordered the Echo Heart she said the it showed the end of my port,
(the catheter) was rubbing against the atrium wall, and she was not sure if that was the reason for the clot, or if it was caused by the Chemo drugs. She said it is very common for cancer patients to develop blood clots in the heart and lungs after Chemo Treatments.
My heart doctor said that he can not understand why the Coumadin has not shrunk the clot at all, and now he says he is not positive that it is a clot. I asked him if it could be that the cancer has spread to my heart. He said it would be very unlikely, because heart cancer is very rare. Do you have any idea what it could be ? Now I am petrified to have them access my port when I get the Herceptin. Also I am so scared that when the time comes to remove the port that there could be complications? I lost over 40 pounds during the Chemo treatments and my Oncologist said that due to the high weight loss, that is the reason that the port shifted and that is what caused the blood clot. She also stopped all blood draws on me and now I am concerned because no one is keeping tract of my markers. So how will they know if the cancer has returned or not. Please help with some answers. Thank You so much!!!
This discussion is related to blood clot in right atrium.
I am 57 years old. My Oncology Doctor does not want to deal with this issue at all, she referred me to a heart doctor. The clot was first discovered in July of 2014 but for some reason I was not told by my Oncologist until the end of October. At that time I was prescribed Coumadin 10 mg. the first day and 5 mg. every day thereafter. Within seven days my blood draws showed I was around 700. The normal range is 200 to 300. It took over a week to get the level to come down. I was then put on two and a half mg. per day. I had a blood draw and again it was still too high. So now I am on 1 mg. per day and it is too low. So the doctor informed me that it could take me some time to get to the correct therapeutic level.
Today the heart doctor ordered another Echo Heart Scan. He showed me the clot and said it was large and was against the wall of the right atrium, and the end of the port is pressed against the clot. He now wants me to go in the hospital and he said they would go down my throat with a camera and get better pictures of the clot. When the Oncologist ordered the Echo Heart she said the it showed the end of my port,
(the catheter) was rubbing against the atrium wall, and she was not sure if that was the reason for the clot, or if it was caused by the Chemo drugs. She said it is very common for cancer patients to develop blood clots in the heart and lungs after Chemo Treatments.
My heart doctor said that he can not understand why the Coumadin has not shrunk the clot at all, and now he says he is not positive that it is a clot. I asked him if it could be that the cancer has spread to my heart. He said it would be very unlikely, because heart cancer is very rare. Do you have any idea what it could be ? Now I am petrified to have them access my port when I get the Herceptin. Also I am so scared that when the time comes to remove the port that there could be complications? I lost over 40 pounds during the Chemo treatments and my Oncologist said that due to the high weight loss, that is the reason that the port shifted and that is what caused the blood clot. She also stopped all blood draws on me and now I am concerned because no one is keeping tract of my markers. So how will they know if the cancer has returned or not. Please help with some answers. Thank You so much!!!
This discussion is related to blood clot in right atrium.
I'm sorry to hear that you are in such a complicated and worrisome situation. I really have no answers to the technical questions, such as what the mass in your atrium might be if it is not a blood clot or a tumor. Answering that question is the purpose of further testing, and as difficult as it is to be patient, I do not see any alternative to taking things as they come, step by step. It is the same with the absence of blood draws. I have not had cancer and am not a doctor, so I think your own oncologist is the best source to clarify that issue for you.
If you do not get a good answer about the blood draws from your own oncologist, consider getting a second opinion from a different oncologist -- or perhaps just ask your PCP to help you understand the situation better. There are also books available that might help, such as The Breast Cancer Survival Manual, by John Link MD, and there are specialized online support forums on breast cancer.
Certainly, you do not want your disease to advance to stage 4, but if it does, it is not an automatic death sentence. Breast cancer is one of the most-researched types of cancer, and treatment strategies are advancing every day. There now are patients who were diagnosed with stage 4 breast cancer who have recovered and have lived for a long time with no evidence of disease.
Please continue reaching out for support, both from your own medical experts and from your real-life and online peers. There is a Breast Cancer Community here on Medhelp that looks to be fairly active. There are a lot of other breast cancer patient forums on other sites on the internet. I believe that somewhere out there is a patient who has successfully gone through exactly what you are going through now.
Last but not least, please consider getting treatment for anxiety. When people have a lot of "what if" type questions, it is a tip-off that anxiety is an issue, in and of itself. I'm not minimizing the very real problems that you are trying to deal with in your life, but the anxiety causes additional suffering, and you don't need that. There are psychotherapeutic and pharmaceutical treatments that can be very helpful in coping with the emotional stress of even an extreme situation. Good luck.
If you do not get a good answer about the blood draws from your own oncologist, consider getting a second opinion from a different oncologist -- or perhaps just ask your PCP to help you understand the situation better. There are also books available that might help, such as The Breast Cancer Survival Manual, by John Link MD, and there are specialized online support forums on breast cancer.
Certainly, you do not want your disease to advance to stage 4, but if it does, it is not an automatic death sentence. Breast cancer is one of the most-researched types of cancer, and treatment strategies are advancing every day. There now are patients who were diagnosed with stage 4 breast cancer who have recovered and have lived for a long time with no evidence of disease.
Please continue reaching out for support, both from your own medical experts and from your real-life and online peers. There is a Breast Cancer Community here on Medhelp that looks to be fairly active. There are a lot of other breast cancer patient forums on other sites on the internet. I believe that somewhere out there is a patient who has successfully gone through exactly what you are going through now.
Last but not least, please consider getting treatment for anxiety. When people have a lot of "what if" type questions, it is a tip-off that anxiety is an issue, in and of itself. I'm not minimizing the very real problems that you are trying to deal with in your life, but the anxiety causes additional suffering, and you don't need that. There are psychotherapeutic and pharmaceutical treatments that can be very helpful in coping with the emotional stress of even an extreme situation. Good luck.
Thank you so much for responding to my post. In regards to my receiving chemo, at the present time I am only receiving Herceptin. This is because I started receiving it in February of 2014, along with all of the other needed chemo drugs. I completed the full regimen in August except for the Herceptin. I go every three weeks to receive the Herceptin until February 2015. My oncologist said that she feels I no longer need blood draws because I am only receiving the Herceptin. I just wonder how I would know if the cancer has returned if no one is monitoring my markers? When I was first diagnosed with stage 3 breast cancer my Oncologist said that I would have to be monitored closely because she said there is a good chance of the cancer coming back, and if it moved beyond the breasts that I would be classified as stage 4, which is incurable? I also completed 33 rounds of radiation. In the past I have never had a problem with high blood pressure but at one of my most recent visits to the heart doctor, he checked my blood pressure three times, and said it was high. He said they would have to keep an eye on my blood pressure in the future. I wonder if it is caused by all of the stress from this blood clot. I am afraid that if they remove my port or reposition it I may have a stroke or it will cause the blood clot to move? I just wonder if it turns out that it is not a blood clot or cancer in my heart , then what could it possibly be? Please respond back if you have any answers or suggestions.
I'm so sorry you are having these problems. The best advice I can give you is to take one step at at time, and go ahead and have the test where the doctor puts the tube down your throat and gets a better look at the clot. I think the test that he is probably wanting to do is a trans-esophageal echocardiogram (TEE). If I'm right, it will be an echo wand that he puts down your throat. Images of the heart from a TEE are clearer and more detailed than those from the echocardiogram that you had before, where I assume a technician moved an echo wand around the outside of your chest. (That kind of echo is called a trans-thoracic echocardiogram, because the echo wand is sending sound waves through your chest wall.)
It is vanishingly rare, almost unheard of, for cancer to metastasize to the heart itself. Heart muscle cells do not multiply, at least not to any significant degree, and so there is little potential for them to multiply out of control. Sometimes a primary cancer will metastasize to the pericardium (which is an enclosed "sac" of tissue that contains the heart), but pericardial tumors are found on the outside of the heart, and if I understand you correctly, your doctors can clearly see that this mass is inside one of the heart chambers. So it is probably not a cancerous tumor that is inside your atrium. If, after you have this next test, your cardiologist is still not sure what the mass is, I would ask for a consultation with a radiologist.
The most obvious explanation of what is going on, to my mind, is what has already been mentioned: that the catheter has moved down into the right atrium and is rubbing on the interior wall of the atrium and has caused a clot. Assuming it is a clot, the doctors will probably want to reposition or replace the catheter. If they don't propose that, I would directly ask about it, because it stands to reason that until it is repositioned or replaced, it will continue to cause a problem.
If your cardiologist has no answer as to why the clot is not dissolving by means of coumadin, I would ask for a consultation with a hematologist. As for your oncologist's not wanting to do blood tests for your cancer markers in the meantime, may I ask if your chemo been suspended until the issue of the blood clot is resolved? If so, then the lack of blood draws is probably because the purpose of the blood draws is to monitor the progress of the chemo, and there is no need to monitor the progress of the chemo until the chemo can be resumed.
I hope that all of your questions can be quickly answered by your doctors and that the obstacles to your treatment are quickly removed. Good luck.
It is vanishingly rare, almost unheard of, for cancer to metastasize to the heart itself. Heart muscle cells do not multiply, at least not to any significant degree, and so there is little potential for them to multiply out of control. Sometimes a primary cancer will metastasize to the pericardium (which is an enclosed "sac" of tissue that contains the heart), but pericardial tumors are found on the outside of the heart, and if I understand you correctly, your doctors can clearly see that this mass is inside one of the heart chambers. So it is probably not a cancerous tumor that is inside your atrium. If, after you have this next test, your cardiologist is still not sure what the mass is, I would ask for a consultation with a radiologist.
The most obvious explanation of what is going on, to my mind, is what has already been mentioned: that the catheter has moved down into the right atrium and is rubbing on the interior wall of the atrium and has caused a clot. Assuming it is a clot, the doctors will probably want to reposition or replace the catheter. If they don't propose that, I would directly ask about it, because it stands to reason that until it is repositioned or replaced, it will continue to cause a problem.
If your cardiologist has no answer as to why the clot is not dissolving by means of coumadin, I would ask for a consultation with a hematologist. As for your oncologist's not wanting to do blood tests for your cancer markers in the meantime, may I ask if your chemo been suspended until the issue of the blood clot is resolved? If so, then the lack of blood draws is probably because the purpose of the blood draws is to monitor the progress of the chemo, and there is no need to monitor the progress of the chemo until the chemo can be resumed.
I hope that all of your questions can be quickly answered by your doctors and that the obstacles to your treatment are quickly removed. Good luck.
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