• Bo Li, Yuan Liu, Zhiyang Lou, Weihua Zhang, Mingyou Zhang, and Quan Liu.
• Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China.
• Medicine (Baltimore). 2022 Apr 22; 101 (16): e29116e29116.

RationaleMediastinal radiotherapy is a common practice for treating breast cancer and Hodgkin's lymphoma. Radiotherapy causes cardiovascular damage and has attracted increasing attention, particularly among Hodgkin's lymphoma patients, as they receive a higher dose of radiation.Patient ConcernsA 36-year-old woman with a past medical history of Hodgkin's lymphoma presented with persistent chest pain for 3 hours. She experienced exertional chest pain 1 month before when she was climbing stairs, which disappeared after a few minutes with rest, but recurred with a similar level of exertion. Three hours before admission to the emergency room, the chest pain persisted and was accompanied by diaphoresis and dyspnea.DiagnosisCardiogenic shock caused by radiotherapy-induced left main coronary artery disease.InterventionsUrgent angiography revealed left main coronary artery stenosis. Intravascular ultrasonography showed diffuse fibrous proliferation in the left main coronary artery. Hemodynamic instability was resolved after drug-eluting stent implantation.OutcomesThe patient was discharged uneventfully 5 days after the procedure, with a prescription for dual antiplatelet and statin therapy. She was asymptomatic with good exercise tolerance at the 3-month follow-up.ConclusionRadiotherapy-induced isolated left main coronary artery disease is a rare complication of cancer radiotherapy and can occur years or decades after treatment. Fibrous proliferation is a characteristic pathologic change in the exposed coronary arteries.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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