Om A, Ellahham S, Vetrovec G W
Department of Internal Medicine, Medical College of Virginia, Richmond 23298.
Am Heart J. 1992 Dec;124(6):1598-602. doi: 10.1016/0002-8703(92)90078-a.
Excessive unprotected radiation to the heart appears to lead to the development of CAD, even in the absence of significant cardiovascular risk factors. The coexistence of such factors may enhance the probability of CAD. The presence of hypercholesterolemia and concomitant or sequential use of chemotherapeutic agents (especially doxorubicin) could further increase this risk. Therapeutic decisions, as with any other manifestation of CAD, relate to the extent of myocardium at jeopardy and to the overall diffuseness of CAD. Management options possible are PTCA or coronary artery bypass surgery. The latter may be required in left main artery stenosis and complicated ostial lesions. Use of shielding should decrease the associated risk of radiation-induced CAD in future years. However, clinicians should continue to have a high degree of suspicion of CAD in patients treated with thoracic radiation without cardiac shielding.
即使没有明显的心血管危险因素，心脏接受过多的无防护辐射似乎也会导致冠心病的发生。这些因素的共存可能会增加患冠心病的概率。高胆固醇血症的存在以及同时或相继使用化疗药物（尤其是阿霉素）可能会进一步增加这种风险。与冠心病的任何其他表现一样，治疗决策与处于危险中的心肌范围以及冠心病的整体弥漫程度有关。可能的治疗选择是经皮冠状动脉腔内血管成形术（PTCA）或冠状动脉搭桥手术。左主干动脉狭窄和复杂的开口处病变可能需要进行后者。使用屏蔽措施应能降低未来几年辐射诱发冠心病的相关风险。然而，临床医生对于未进行心脏屏蔽而接受胸部放疗的患者，仍应高度怀疑其患有冠心病。
