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Radiation-induced Heart Disease — EECC MCQ

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ModerateGeneral CardiologyRadiation-induced Heart DiseaseEECC

A 65-year-old woman who received mediastinal radiotherapy for Hodgkin lymphoma 25 years ago presents with progressive exertional dyspnoea. Echocardiography shows moderate aortic stenosis, mild-moderate mitral regurgitation, restrictive physiology, and mild pericardial thickening. Coronary angiography shows ostial LAD stenosis. What unifying diagnosis explains these findings?

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Correct answer: D — Radiation-induced heart disease (RIHD)

Radiation-induced heart disease (RIHD) is a well-recognised late complication of mediastinal radiotherapy, typically presenting 10-30 years after treatment. It affects all cardiac structures: (1) pericardium (fibrosis/constriction), (2) myocardium (restrictive cardiomyopathy from fibrosis), (3) valves (fibrosis and calcification, particularly aortic and mitral), (4) coronary arteries (accelerated atherosclerosis with characteristic ostial stenoses), and (5) conduction system. The combination of multi-valve disease, restrictive physiology, pericardial thickening, and ostial coronary stenosis in a patient with prior mediastinal RT is pathognomonic. The 2022 ESC Cardio-Oncology Guidelines recommend lifelong cardiac surveillance for patients treated with mediastinal RT.

Reference: ESC (2022): Guidelines on Cardio-Oncology