Skip to main content
SpringerLink
Log in

Myocardial infarction in young patients with Hodgkin's disease — potential pothogenic role of radiotherapy, chemotherapy, and splenectomy

  • Case Reports
  • Published:
The clinical investigator Aims and scope Submit manuscript

Summary

Among a total of 2147 patients admitted to our hospital for acute myocardial infarction between 1978 and 1987, three young patients aged 24, 29, and 39 years had previously been treated for Hodgkin's disease. Staging laparotomy, including splenectomy, had been performed in all three patients. Two patients had both mediastinal irradiation (21 and 27 months before infarction) and chemotherapy. In the first patient, postmortem histologic examination of the coronary arteries revealed fibrotic changes, which were probably induced by radiotherapy. In our second patient, myocardial infarction developed 5 days after vinblastine treatment; early angiography showed thrombotic occlusion of the proximal right coronary artery, which was recanalized using the diagnostic Sones catheter. Subsequent angiography revealed normal coronary arteries. This is, to our knowledge, the first case of documented coronary artery thrombosis after treatment with vinca-alkaloids. In our third patient, neither mediastinal irradiation nor chemotherapy had been performed prior to myocardial infarction. However, a marked increase in platelet counts following splenectomy was observed in this patient. The role of radiotherapy, chemotherapy, and splenectomy with consecutive thrombocytosis as a third possible pathogenic factor for subsequent development of myocardial infarction is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

LAD:

left anterior descending coronary artery

COPP:

chemotherapy with cyclophosphamide, vincristine, prednisone, and procarbazine

ABVD:

chemotherapy with doxorubicin, bleomycin, vinblastine, and decarbazine

References

  1. Ali MK, Khalil KG, Fuller LM, Leachman RD, Sullivan MP, Loh KK, Gamble JF, Shullenberger CC (1976) Radiation-related myocardial injury. Cancer 38:1941–1946

    Google Scholar 

  2. Allal J, Becq-Giraudon B, Pouget-Abadie JF, Sudre Y, Barraine R (1984) Deux nouveaux cas d'infarctus du myocarde après injection de vincristine. Ann Cardiol Angeiol (Paris) 33:469–470

    Google Scholar 

  3. Amromin GD, Gildenhorn HL, Solomon RD (1964) The synergism of X-irradiation and cholesterol-fat feeding on the development of coronary artery lesions. J Atherosclerosis Res 4:325–334

    Google Scholar 

  4. Angelini A, Benciolini P, Thiene G (1985) Radiation-induced coronary obstructive atherosclerosis and sudden death in a teenager. Int J Cardiol 9:371–373

    Google Scholar 

  5. Annest LS, Anderson RP, Wei-i-Li, Haferman MD (1983) Coronary artery disease following mediastinal radiation therapy. J Thorac Cardiovasc Surg 85:257–263

    Google Scholar 

  6. Applefeld MM, Wiernik PH (1983) Cardiac disease after radiation-therapy for Hodgkin's disease: analysis of 48 patients. Am J Cardiol 51:1679–1681

    Google Scholar 

  7. Bajsogolov GD, Siskin JP (1983) Herzinfarkt, akute Koronarinsuffizienz und plötzlicher Tod bei Lymphogranulomatosekranken nach der Bestrahlung des Mediastinums. Radiobiol Radiother 24:165–170

    Google Scholar 

  8. Barra M, Brignole M, Sartore B, Bertulla A (1985) Infarto del miocardio indotto da vincristina in soggetti con linfoma di Hodgkin. Giornale Italiano di Cardiologica (Rome) 15:107–111

    Google Scholar 

  9. Blijham GH, Fiolet HH, Van Deijk WA, Hupperets PS, Janssen JH (1986) Angina pectoris associated with infusions of 5-FU and vindesine. Cancer Treat Rep 70:314–315

    Google Scholar 

  10. Bodensteiner DC (1981) Fatal coronary artery fibrosis after treatment with bleomycin, vinblastine and cis-platinum. South Med J 74:898–899

    Google Scholar 

  11. Boivin JF, Hutchinson GB (1982) Coronary heart disease mortality after irradiation for Hodgkin's disease. Cancer 49:2470–2475

    Google Scholar 

  12. Borek G, Gebel F, Jenzer HR (1991) Akuter Myokardinfarkt nach Chemotherapie bei Hodenkarzinom: zur koronaren Toxizität der Zytostatika. Schweiz Med Wochenschr 121:385–389

    Google Scholar 

  13. Brosius FC, Waller BF, Roberts WC (1981) Radiation heart disease. Am J Med 70:519–530

    Google Scholar 

  14. Buckner CD, Rudolph RF, FeferA, Clift RA, Epstein RB (1972) High dose cyclophosphamide therapy for malignant disease. Toxicity, tumor response, and the effects of stored autologous marrow. Cancer 29:357–362

    Google Scholar 

  15. Carmel RJ, Kaplan HS (1976) Mantle irradiation in Hodgkin's disease. Cancer 37:2813–2825

    Google Scholar 

  16. Castleman B, McNeely BU, Moloney WC, Burnside JW, Pellegrini JL, Goodman M, Williams JR (1970) Case Records of the Massachusetts General Hospital. N Engl J Med 283:1332–1339

    Google Scholar 

  17. Cohn KE, Stewart JR, Fajardo LF, Hancock EW (1967) Heart disease following radiation. Medicine 46:281–298

    Google Scholar 

  18. Cosgriff SW, Diefenbach AF, Vogt W (1950) Hypercoagulability of the blood associated with ACTH and cortisone therapy. Am J Med 9:752–756

    Google Scholar 

  19. Cosset JM, Henry-Amar M, Pellae-Cosset B, Carde P, Girinski T, Tubiana M, Hayat M (1991) Pericarditis and myocardial infarctions after Hodgkin's disease therapy. Int J Radiat Oncol Biol Phys 21:447–449

    Google Scholar 

  20. Dechy H, Debain P, Levi R, Dorra M, Tulliez M, Remy JM (1978) Infarctus du myocarde après injection de vincristine. Nouvelle Presse Médical 7:2657

    Google Scholar 

  21. Dollinger MR, Lavine DM, Foye LV (1966) Myocardial infarction due to postirradiation fibrosis of the coronary arteries. JAMA 195:316–319

    Google Scholar 

  22. Dunsmore LD, LoPonte MA, Dunsmore RA (1986) Radiation-induced coronary artery disease. J Am Coll Cardiol 8:239–244

    Google Scholar 

  23. Fajardo LF (1977) Radiation-induced coronary artery disease. Chest 71:563–564

    Google Scholar 

  24. Fulton WFM (1978) Coronary thrombotic occlusion in myocardial infarction and the role of thrombus in the pathogenesis of atherosclerosis. In: Carlson LA, Päoletti R, Sirtori CR, Weber G (eds) International conference of atherosclerosis. Raven Press, New York, pp 75–89

    Google Scholar 

  25. Gustavsson A, Eskilsson J, Landberg T, Svahn-Tapper G, White T, Wollmer P, Akerman M (1990) Late cardiac effects after mantle radiotherapy in patients with Hodgkin's disease. Ann Oncol 1:355–363

    Google Scholar 

  26. Hamilton DV, Reed PJ (1978) Myocardial infarktion following radiotherapy for Hodgkin's disease. Br J Clin Pract 32:181

    Google Scholar 

  27. Harris AL, Wong C (1981) Myocardial ischaemia, radiotherapy and vinblastine. Lancet 1:787

    Google Scholar 

  28. Huff H, Sanders FM (1972) Coronary-artery occlusion after radiation. N Engl J Med 286:780

    Google Scholar 

  29. Joensuu H (1989) Acute myocardial infarction after heart irradiation in young patients with Hodgkin's disease. Chest 95:388–390

    Google Scholar 

  30. Kopelson G, Herwig KJ (1978) The etiologies of coronary artery disease in cancer patients. Int J Radiat Oncol Biol Phys 4:895–906

    Google Scholar 

  31. Lejonc JL, Vernant JP, Macquin J, Castaigne A (1980) Myocardial infarction following vinblastine treatment. Lancet II:692

    Google Scholar 

  32. Leong ASJ, Forbes IJ, Ruzic T (1979) Radiation-related coronary artery disease in Hodgkin's disease. Aust N Z J Med 9:423–425

    Google Scholar 

  33. Mandel EM, Lewinski U, Djaldetti M (1975) Vincristine-induced myocardial infarction. Cancer 36:1979–1982

    Google Scholar 

  34. Marti V, Lopez-Morales J, Bailen JL, Auge JM (1991) Coronary disease after the radiotherapy of the mediastinum in Hodgkin's disease. Rev Clin Esp 189:26–28

    Google Scholar 

  35. McReynolds RA, Gold GL, Roberts WC (1976) Coronary heart disease after mediastinal irradiation for Hodgkin's disease. Am J Med 60:39–45

    Google Scholar 

  36. Mittal B, Deutsch M, Thompson M, Dameshek HL (1986) Radiation-induced accelerated coronary arteriosclerosis. Am J Med 81:183–184

    Google Scholar 

  37. Murphy GK (1977) Cancer and the coroner. JAMA 237:786–788

    Google Scholar 

  38. Prentice RTW (1965) Myocardial infarction following radiation. Lancet II:388

    Google Scholar 

  39. Radwaner BA, Geringer R, Goldmann AM, Schwartz MJ, Kemp HG (1987) Left main coronary artery stenosis following mediastinal irradiation. Am J Med 82:1017–1020

    Google Scholar 

  40. Rasmussen S, Dossing M, Jorgensen SW (1978) Coronary heart disease — a possible risk in megavoltage therapy? Acta Med Scand 203:237–239

    Google Scholar 

  41. Robertson JH, Crozier EH, Woodend BE (1972) Vincristine induced thrombocytosis studied with 75Se selenomethionin. Acta Haematol 47:356–360

    Google Scholar 

  42. Robinette CD, Fraumeni JF (1977) Splenectomy and subsequent mortality in veterans of the 1939–45 war. Lancet II:127–129

    Google Scholar 

  43. Rodgers DL (1976) Precocious myocardial infarction after radiation treatment for Hodgkin's disease. Chest 70:675–677

    Google Scholar 

  44. Scholz KH, Tebbe U, Herrmann C, Wojcik J, Lingen R, Chemnitius JM, Brune S, Kreuzer H (1992) Frequency of complications of cardiopulmonary resuscitation after thrombolysis during acute myocardial infarction. Am J Cardiol 69:724–728

    Google Scholar 

  45. Schwarzer S, Eber B, Greinix H, Lind P (1991) Non-Q-wave myocardial infarction associated with bleomycin and etoposide chrmotherapy. Eur Heart J 12:748–750

    Google Scholar 

  46. Simon EB, Ling J, Mendizabal RC, Midwall J (1984) Radiation-induced coronary artery disease. Am Heart J 108:1032–1034

    Google Scholar 

  47. Somers G, Abramow M, Wittek M, Naets JP (1976) Myocardial infarction: a complication of vincristine treatment? Lancet II:690

    Google Scholar 

  48. Stewart JR, Fajardo LF (1984) Radiation-induced heart disease: an update. Prog Cardiovasc Dis 27:173–194

    Google Scholar 

  49. Subar M, Muggia FM (1986) Apparent myocardial ischemia associated with vinblastine administration. Cancer Treat Rep 70:690–691

    Google Scholar 

  50. Tavcar I, Malesevic M, Ciko Z (1980) Myocardial infarct after treatment of Hodgkin's disease with vincristine. Srp Arh Celok Lek 108:1325–1331

    Google Scholar 

  51. Tötterman KJ, Pesonen E, Siltanen P (1983) Radiation-related chronic heart disease. Chest 6:875–878

    Google Scholar 

  52. Tres A, Fuertes MA, Callen L, Poderos C, Rodrigo G, Peleato A, Polo J, Gutierrez M (1984) Infarto de miocardio tras radioterapía mediastinica por enfermedad de Hodkin. Rev Esp Oncol 31:477–482

    Google Scholar 

  53. Voelker W, Schuler U, Ehninger G, Jacksch R, Mauser M, Steidle B, Karsch KR (1987) Vorderwandinfarkt bei einem 18jährigen Patienten mit M. Hodgkin. Dtsch Med Wochenschr 112:1216–1219

    Google Scholar 

  54. Weinstein P, Greenwald ES, Grossman J (1976) Unusual cardiac reaction to chemotherapy following mediastinal irradiation in a patient with Hodgkin's disease. Am J Med 60:152–156

    Google Scholar 

  55. Yahalom J, Hasin J, Fuks Z (1983) Acute myocardial infarction with normal coronary arteriogram after mantle field radiation therapy for Hodgkin's disease. Cancer 52:637–641

    Google Scholar 

  56. Yancey RS, Talpaz M (1982) Vindesine-associated angina and ECG changes. Cancer Treat Rep 66:587–589

    Google Scholar 

  57. Zeymer U, Neuhaus KL (1989) Infarkttypische Veränderungen im Elektrokardiogramm nach Chemotherapie mit Vinblastin. Dtsch Med Wochenschr 114:589–592

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung Kardiologie, Universität Göttingen, Robert-Koch-Strasse 40, W-3400, Göttingen, FRG

    K. H. Scholz, C. Herrmann, U. Tebbe, J. M. Chemnitius & H. Kreuzer

  2. Abteilung Pathologie, Georg-August Universität Göttingen, Robert-Koch-Strasse 40, W-3400, Göttingen, FRG

    U. Helmchen

Authors
  1. K. H. Scholz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Herrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Tebbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. M. Chemnitius
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Helmchen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Kreuzer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scholz, K.H., Herrmann, C., Tebbe, U. et al. Myocardial infarction in young patients with Hodgkin's disease — potential pothogenic role of radiotherapy, chemotherapy, and splenectomy. Clin Investig 71, 57–64 (1993). https://doi.org/10.1007/BF00210966

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00210966

Key words

Search

Navigation