Persistent Angina With Nonobstructive Coronary Artery Disease: Unmasking Coronary Microvascular Dysfunction Post-Oncotherapy.

BACKGROUND

Coronary microvascular dysfunction (CMD) is frequently the cause of patients presenting with angina with nonobstructed coronary arteries and may have increased prevalence in cancer survivors.

CASE SUMMARY: We report a case of refractory angina in a survivor of Hodgkin lymphoma, previously treated with radiotherapy and chemotherapy. After demonstrating unobstructed epicardial arteries, advanced diagnostics including quantitative stress perfusion cardiac magnetic resonance and invasive coronary physiology testing, revealed CMD as a likely sequela of oncotherapy and informed initiation of mechanism-specific treatment.

DISCUSSION: CMD may represent an under-recognized cardiotoxicity of oncotherapy. This case highlights the value of formal, multimodal coronary microvascular function assessment to identify CMD and implement stratified management. Future systematic evaluation investigating the relationship and underlying mechanisms of oncotherapy in CMD is warranted.

TAKE-HOME MESSAGE: In cancer survivors presenting with angina with nonobstructed coronary arteries, clinicians should have a high index of suspicion for CMD and consider systematic evaluation to guide stratified treatment.