Alsara Osama, Alsarah Ahmad, Kalavakunta Jagadeesh K, Laird-Fick Heather, Abela George S
Michigan State University, Department of Internal Medicine, B-301 Clinical Center, East Lansing, MI 48824, USA.
Michigan State University, Division of Cardiovascular Disease, B-208 Clinical Center, East Lansing, MI 48824, USA.
Case Rep Med. 2013;2013:834164. doi: 10.1155/2013/834164. Epub 2013 Dec 12.
Radiation therapy of neoplasms involving the chest or mediastinum results in a wide spectrum of cardiac complications including coronary artery disease, which can present in patients with few or no traditional cardiac risk factors. We report a case of radiation induced coronary artery disease in a 60-year-old female with a history of stage IIIA nonsmall cell lung carcinoma which was diagnosed eight years earlier and treated with chemotherapy and radiotherapy. She presented to the hospital with atypical chest pain that had occurred intermittently over the preceding week. Her initial electrocardiogram and cardiac enzymes were within normal limits. However, following an indeterminate exercise nuclear stress test, she developed chest pain and elevated cardiac enzymes. Coronary angiography demonstrated 90% stenosis of the left main coronary artery ostium, without any evidence of atherosclerotic disease or stenosis in other coronary arteries. She underwent surgical revascularization, which revealed dense adhesions surrounding the heart. During surgery, she developed severe bleeding and died. Coronary artery disease can present within years of radiation exposure, and ostial lesions are typical. Treatment is often challenging because of the effects of radiation on other tissues and the risks of revascularization procedures. Therefore, a multidisciplinary team approach should be considered.
涉及胸部或纵隔的肿瘤进行放射治疗会导致一系列心脏并发症，包括冠状动脉疾病，这种疾病可出现在几乎没有或没有传统心脏危险因素的患者中。我们报告一例60岁女性因放射诱发冠状动脉疾病的病例，该患者有8年前诊断为IIIA期非小细胞肺癌的病史，曾接受化疗和放疗。她因在前一周间歇性出现的非典型胸痛入院。她最初的心电图和心肌酶均在正常范围内。然而，在进行了一次结果不确定的运动核素负荷试验后，她出现胸痛且心肌酶升高。冠状动脉造影显示左主冠状动脉口狭窄90%，其他冠状动脉无动脉粥样硬化疾病或狭窄迹象。她接受了外科血运重建术，术中发现心脏周围有致密粘连。手术过程中，她出现严重出血并死亡。冠状动脉疾病可在放射暴露数年之内出现，且开口处病变很典型。由于放射对其他组织的影响以及血运重建手术的风险，治疗往往具有挑战性。因此，应考虑采用多学科团队方法。
