Radiation associated heart disease

Radiation associated heart disease

Radiation associated heart disease is more noted in survivors of breast cancer and Hodgkin’s disease who had undergone radiotherapy with incidental radiation to the heart. The risk is higher in those who received chemotherapy with agents like anthracyclines in addition to radiation. The features of radiation associated cardiac ailment could involve all the three layers of the heart with pericarditis, myocardial fibrosis or dysfunction, and valvular damage.

Symptoms may occur years or decades after radiation exposure [1]. But when to intervene needs careful considerations as second surgeries in these patients is often complex and high risk. Second surgeries should be minimized in the long term as far as possible.

Radiation is one of the few conditions, which can cause co-existence of restrictive heart disease with constrictive pericarditis. The conduction system of the heart can also be involved in radiation associated heart disease.

Higher doses and younger age at therapy as well as longer follow up will increase the cumulative incidence of radiation-associated heart disease. Advances in radiotherapy techniques can certainly reduce the dose and volume of exposure to the heart and help in lowering the risk of radiation associated heart disease.

Reference

1. Milind Y Desai, Christine L Jellis, Rupesh Kotecha, Douglas R Johnston, Brian P Griffin. Radiation-Associated Cardiac Disease: A Practical Approach to Diagnosis and Management. JACC Cardiovasc Imaging. 2018 Aug;11(8):1132-1149.