CMML Cardiac Complications — RACP Adult Medicine MCQ

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HardHaematologyCMML Cardiac ComplicationsRACP Adult Medicine

A 62-year-old man with chronic myelomonocytic leukaemia (CMML) on azacitidine develops acute chest pain and troponin rise. Coronary angiography shows normal coronary arteries. His monocyte count is 15 × 10⁹/L. What is the most likely cardiac diagnosis?

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Correct answer: E — Coronary microvascular dysfunction from monocyte-mediated inflammation

CMML is characterised by persistent monocytosis. Elevated monocytes infiltrate vessel walls and contribute to coronary microvascular disease. Troponin elevation with normal epicardial coronary arteries in CMML can represent myocardial infiltration or microvascular dysfunction. This is an emerging area of cardio-oncology. Treatment focuses on the underlying CMML (cytoreductive therapy) and standard ACS secondary prevention. Cardiac MRI may show patchy late gadolinium enhancement suggesting inflammation or infiltration.

Reference: eTG – 2025 – Haematology; ESC – 2022 – Cardio-Oncology Guidelines