Persistent angina with non-obstructive coronary artery disease: unmasking coronary microvascular dysfunction post-oncotherapy
Author(s)
Macanovic, Philip
Cheng, Kevin
Ramasamy, Anantharaman
Baksi, John
De Silva, pettahandige
Type
Journal Article
Abstract
Background
Coronary microvascular dysfunction (CMD) is frequently the cause of patients presenting with
angina and non-obstructed coronary arteries (ANOCA) 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 MRI 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 messages
In cancer survivors presenting with ANOCA, clinicians should have a high index of suspicion for CMD and consider systematic evaluation to guide stratified treatment.
Coronary microvascular dysfunction (CMD) is frequently the cause of patients presenting with
angina and non-obstructed coronary arteries (ANOCA) 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 MRI 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 messages
In cancer survivors presenting with ANOCA, clinicians should have a high index of suspicion for CMD and consider systematic evaluation to guide stratified treatment.
Date Issued
2025-07-02
Date Acceptance
2025-02-24
Citation
JACC: Case Reports, 2025, 30 (17)
ISSN
2666-0849
Publisher
Elsevier
Journal / Book Title
JACC: Case Reports
Volume
30
Issue
17
Copyright Statement
© 2025, The Authors. Published by Elsevier on Behalf of The American College of Cardiology Foundation. This is an Open Access Article under the CC BY License (http://creativecommons.org/licenses/by/4.0/).
License URL
Publication Status
Published
Date Publish Online
2025-07-02