Based on PubMed | Can oral cancer or its treatments cause heart palpitations?

Heart palpitations can occur in people with oral cancer, most often as a side effect of certain treatments rather than from the cancer in the mouth itself. ^[1] Treatments commonly used for head and neck/oral cancers such as fluoropyrimidine chemotherapy (5‑fluorouracil or capecitabine), platinum agents (cisplatin or carboplatin), taxanes (paclitaxel/docetaxel), and immune checkpoint inhibitors (pembrolizumab/nivolumab) have all been linked, to varying degrees, with heart rhythm problems, chest discomfort, or other heart issues that can feel like a racing or irregular heartbeat. ^{[2] [3]}

What palpitations feel like

• A fluttering, pounding, or racing heartbeat
• Skipped beats or an irregular rhythm
• Sometimes paired with chest pain, shortness of breath, dizziness, or fatigue
  If any of these symptoms are new, severe, or persistent, it’s important to tell your oncology team promptly, as some treatment‑related heart effects can be serious but treatable when caught early. ^{[4] [5]}

How oral cancer treatments can lead to palpitations

Fluoropyrimidines (5‑FU, capecitabine)

• These drugs can cause coronary artery spasm sudden tightening of the heart’s arteries leading to chest pain and sometimes arrhythmias that feel like palpitations. ^[6]
• Arrhythmias and even heart attacks have been reported, most often early in treatment, and risk may be higher with prior heart disease or when combined with other cardiotoxic drugs. ^[3]
• Because of this risk, new chest symptoms or abnormal heartbeats during 5‑FU/capecitabine therapy should be assessed urgently. ^[3]

Platinum agents (cisplatin, carboplatin)

• While not as classically arrhythmogenic as 5‑FU, platinum‑based regimens for head and neck cancers include warnings for abnormal heartbeat, chest tightness, and shortness of breath, and patients may undergo heart testing before or during therapy. ^{[7] [5]}
• Patient guides for cisplatin/5‑FU/pembrolizumab and carboplatin/5‑FU/pembrolizumab specifically list “abnormal heartbeat” and advise immediate reporting of these symptoms. ^{[4] [5]}

Taxanes (paclitaxel/docetaxel)

• Taxanes are among cytotoxic drugs associated with cardiovascular complications, including arrhythmias, which can present as palpitations. ^[2]

Immunotherapy (PD‑1/PD‑L1 and CTLA‑4 inhibitors)

• Immune checkpoint inhibitors can rarely inflame the heart muscle (myocarditis) or cause arrhythmias and conduction problems; palpitations can be an early symptom. ^{[8] [9]}
• Guidance for nivolumab emphasizes that immune‑related cardiotoxicity arrhythmia, myocarditis, heart failure though uncommon, is serious and requires prompt evaluation. ^[8]

Chemoradiation combinations

• Combined regimens (e.g., cisplatin + 5‑FU with or without radiation) are standard for many head and neck cancers and carry the 5‑FU‑related spasm/arrhythmia risk plus the platinum‑related warnings. ^{[6] [7]}

Does oral cancer itself cause palpitations?

Oral cavity tumors primarily cause local symptoms mouth sores that don’t heal, lumps, pain, difficulty swallowing, voice changes, ear pain, or jaw stiffness rather than heart rhythm symptoms. ^{[10] [11]} While stress, pain, dehydration, anemia, infection, or thyroid issues during cancer care can indirectly trigger palpitations, the mouth cancer itself is not a typical direct cause of heart rhythm abnormalities. ^[1]

When to seek help

• New chest pain/tightness, shortness of breath, or an abnormal heartbeat during chemotherapy or immunotherapy should be reported immediately or evaluated in an emergency department, as advised in head and neck cancer treatment guides. ^{[4] [5]}
• Heart problems with these regimens are described as uncommon but potentially serious, and they may occur early in treatment or even after it finishes. ^{[7] [5]}

Who is at higher risk

• Prior heart disease, high blood pressure, or previous treatment with heart‑affecting drugs can increase risk of treatment‑related palpitations. ^{[4] [5]}
• Fluoropyrimidine‑related events are more likely in those with underlying coronary disease or with concurrent cardiotoxic drugs. ^[3]

How doctors evaluate and manage palpitations during treatment

• Depending on your symptoms and regimen, your team may order an ECG (electrocardiogram), blood tests (e.g., troponin for heart injury), echocardiogram, or cardiac MRI, and may consult cardio‑oncology. ^[9]
• For suspected 5‑FU/capecitabine vasospasm or arrhythmia, stopping the drug and cardiology referral are recommended; treatments can include anti‑anginal medicines and rhythm monitoring. ^[3]
• For suspected immunotherapy‑related myocarditis or arrhythmia, treatment often includes holding immunotherapy and starting high‑dose steroids, with urgent cardiac evaluation. ^[12]
• Some regimens include baseline and on‑treatment heart assessments to catch problems early. ^[5]

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Quick reference: treatments and palpitations

Treatment class	Can it cause palpitations?	Typical mechanism/notes
5‑FU/capecitabine (fluoropyrimidines)	Yes	Coronary artery spasm and arrhythmias; often early in therapy; report chest pain or irregular heartbeat promptly. [6] [3]
Cisplatin/carboplatin (platinum agents)	Possible	Patient guides list abnormal heartbeat and recommend immediate reporting; may require heart testing. [7] [5]
Taxanes (paclitaxel/docetaxel)	Possible	Cytotoxic drugs linked with arrhythmias and other cardiovascular effects. [2]
Immunotherapy (pembrolizumab/nivolumab)	Rare but serious	Immune‑mediated myocarditis and arrhythmias can occur; prompt evaluation is critical. [8] [9]
Head/neck radiation alone	Uncommon cause of palpitations	Head/neck radiation mainly causes local side effects (mouth dryness, swallowing difficulty); chest radiation is more associated with heart effects. [13]

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Bottom line

• Palpitations during oral cancer treatment are most commonly linked to specific therapies especially 5‑FU/capecitabine, platinum‑based combinations, taxanes, and immune checkpoint inhibitors rather than the tumor itself. ^{[2] [7]}
• Although uncommon, these heart effects can be serious, and any new chest symptoms or irregular heartbeat should be reported immediately for assessment. ^{[4] [5]}

If you’re experiencing palpitations now, consider keeping a brief symptom log (time, duration, triggers, associated chest pain or shortness of breath), avoid stimulants like excess caffeine, and contact your oncology team promptly for guidance and possible heart testing. ^[5]