Heart diseases following radiotherapy.

Three women had cardiac complaints 10-17 years after a radical mastectomy and radiotherapy for cancer of the left breast. Their ages were 42, 43 and 57 years, respectively. The first patient had a precocious coronary artery disease (CAD). She had segmental stenosis in the middle and distal portions of the left main coronary artery and pericardial fibrosis. Symptoms and signs of severe pericardial constriction became the problem after bypass surgery. She died 1 year later due to cardiorespiratory failure. The second case had sick sinus syndrome presenting a prolonged pause for 12 seconds alternating with tachy- and bradyarrhythmias, a complete atrio-ventricular block in association with pericardial effusion plus aortic and mitral valvular regurgitation. The condition improved after the implantation of a permanent pacemaker. To date, this is a very rare complication of radiation induced panconduction disturbance. The third patient had significant stenosis in the proximal portion of the left anterior descending coronary artery and myocardial fibrosis was proven by an endocardial biopsy. She had an uneventful course after medical treatment.