Coronary artery disease following mediastinal irradiation

Mediastinal irradiation is a known cause of late onset cardiac complications including coronary artery disease. We describe a 58-year-old female patient, without any of the traditional coronary risk factors, who presented with inferior infarction 23 years after radiotherapy for Hodgkin's lymphoma of the mediastinum. Coronary angiography demonstrated severe ostial stenoses of both coronary arteries. The patient underwent coronary artery bypass grafting and is doing well 10 months later. The therapeutic value of mediastinal irradiation is unquestionable. However, it may be associated with late complications from the irradiated tissues, including the heart. Long-term follow up of cancer survivors who have received mediastinal irradiation should therefore include annual cardiac ultrasound examinations, as well as functional testing for the detection of myocardial ischaemia.