radiation-induced heart disease

Epidemiology: - increased likelihood with 3600-4000 Gy of cardiac radiation Pathology: 1) myocardial fibrosis a) microvascular ischemia at the level of myocardial capillaries b) diastolic dysfunction is common 2) effusive pericarditis a) most commonly during 1st 6 months after radiation b) generally asymptomatic c) appearance may be delayed for years 3) constrictive pericarditis 4) radiation induced valvular heart disease 5) cardiac conduction system disease 6) radiation-induced coronary artery disease (CAD) a) distinct from atherosclerotic CAD b) tendency to involve osteal & proximal coronary arteries c) greater extent of intimal fibrosis & adventitial thickening Clinical manifestations: 1) effusive pericarditis a) generally asymptomatic b) occasionally patients complain of exertional dyspnea 2) occult constrictive pericarditis a) unexplained exertional dyspnea b) occurs several years after radiation c) jugular venous distension may be noted d) no edema e) no pericardial knock 3) symptoms associated with constrictive pericarditis Management: 1) increased likelihood of atherosclerosis 2) friability of internal mammary artery when used as a bypass conduit for CABG 3) constrictive pericarditis a) seldom need pericardiectomy b) symptoms generally controlled with diuretics 4) no established guidelines for long-term follow-up

Related

pericarditis radiation therapy (XRT)

General

heart disease (cardiac disease) radiation injury; radiation toxicity

References

Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998