Long-Term Radiotherapy-Induced Cardiac Complications: A Case Report

Abstract

Patient: Male, 48Final Diagnosis: Late cardiac complications postradiotherapySymptoms: Chest pain • dyspnea • syncopeMedication: —Clinical Procedure: Diagnostic and therapeutic techniques in cardiologySpecialty: CardiologyObjective:Unusual or unexpected effect of treatmentBackground:Tumor disease has improved survival due to therapeutic advances and early diagnosis. However, anti-neoplastic treatment involves generating harmful side effects in the body, both in the short-term and in the long-term. One of the most important side effects is cardiovascular disease after radiotherapy, which in addition to being influenced by classic cardiovascular risk factors, can be also be influenced by anti-neoplastic therapy, and represents the main cause of death after a second cancer. We present a case that synthesizes the most relevant and determining aspects of radiotherapy-induced heart disease.Case Report:We present the case of a 48-year-old male with a personal history of mediastinal Hodgkin lymphoma who was treated with local radiotherapy 20 years ago, and who was admitted to hospital due to dyspnea and oppressive chest pain with efforts. He was diagnosed with severe aortic stenosis, and a coronary angiography confirmed the existence of coronary disease. Two years before, he had been admitted to hospital due to syncope and a pacemaker had been implanted. This patient experienced several cardiovascular complications that could be attributed to the radiotherapy treatment received in his past.Conclusions:Radiotherapy shows multiple cardiological complications, especially when applied at the thoracic level. This fact is very relevant, and this report can help determine the aspects of radiotherapy-induced heart disease affecting the mortality and morbidity of these patients.

Elemental changes in heart and coronaries after breast cancer radiotherapy assessed by synchrotron radiation soft X-ray spectromicroscopy

“…There is a linear correlation between the dose of radiation received and coronary artery alterations. Studies showed that the chance of coronary events increase by 7.4% per Gy [3,35].…”

Aortic Valve Leaflet Rupture Causing Delayed Left Main Coronary Ostial Obstruction During Valvuloplasty Preceding TAVR

“…Mediastinal radiation therapy has been the standard of care in treating multiple cancers ( 5 ). One of the common late complications of radiation therapy is radiation-induced valvular heart disease, which occurs in about 10%-17% of patients, about 15-20 years after their initial radiation exposure ( 5 , 6 ). AV exposed to mediastinal radiation therapy encompasses more collagen and less calcified tissue than AV not exposed to radiation therapy ( 6 ).…”

“…The risk of focal leaflet rupture is elevated in patients with radiation-induced valvular heart disease because the fibrotic thickening, scarring, retraction, and focal calcifications involve the medial and basal sections of the valve, rather than the valvular tips ( 5 , 6 ). Here, we presented a rare case of AV leaflet rupture after BAV, before TAVR, in a patient with mediastinal radiation exposure leading to radiation-induced valvular heart disease.…”

Complete heart block and moderate stenosis aortic post radiation in a young woman with breast cancer

“…Radiotherapy is an important cancer treatment modality that has resulted in improved survival in patients with a variety of cancers [ 1 ].…”