Premature coronary artery disease in a patient with a history of combined treatment for lymphogranulomatosis: a case report

Introduction. Cancer occupies one of the leading positions in the list of the most common death causes in the world. The widespread use of chemo-, targeted, immune and radiation therapy in clinical practice has increased the survival of cancer patients. However, the incidence of cardiotoxic complications of antitumor therapy has increased significantly, and they may manifest themselves many years after the onset of cancer remission.

Brief description. We present a case of premature coronary artery disease (CAD) in a 40-year-old male patient, who underwent multiagent chemotherapy in combination with radiation therapy for mediastinal lymph nodes due to lymphogranulomatosis at the age of 22. In 2021, against the background of a stressful situation, the patient first noted a burning sensation in chest, which was relieved spontaneously, and an increase in blood pressure to 145/90 mm Hg. After visiting a cardiologist, a clinical, electrocardiographic and echocardiographic (at rest) examination was performed. However, no pathology was found, and therapy was not prescribed. Over the next 3 years, short-term squeezing pain in chest was periodically noted, occurring during fast walking, which was relieved when stopping. In April 2024, the patient was hospitalized in the cardiology department of the University Clinic of the N. A. Semashko Institute of Clinical Medicine of the Russian University of Medicine for an in-depth cardiological examination. Analysis of complaints and anamnestic data, clinical and paraclinical examination, made it possible to diagnose CAD, class III angina pectoris. This was regarded as a late manifestation of cardiotoxicity of chemotherapy in combination with radiation therapy to the mediastinal area, performed at the age of 22 for lymphogranulomatosis. Selective coronary angiography revealed multiple coronary stenoses. For myocardial revascularization, the patient was referred to the I. V. Davydovsky City Clinical Hospital, where 4 drug-eluting stents were inserted. Follow-up monitoring of the cardiovascular system was not carried out. When contacting a cardiologist with complaints typical for coronary insufficiency, CAD was not diagnosed.

Conclusion. The presented case shows the difficulties in diagnosing long-term manifestations of cardiotoxicity in the form of premature CAD. It is necessary to conduct additional educational activities and introduce modern technological products to improve the effectiveness of primary prevention, diagnosis and treatment of cardiotoxicity of antitumor therapy.

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