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CardioNerds (Dr. Patrick Azcarate, Dr. Teodora Donisan, and Amit Goyal) discuss Radiation-Associated Cardiovascular Disease (RACD) with Dr. Eric Yang, cardio-oncologist, assistant professor of medicine, and associate fellowship program director at UCLA.\n\n\n\nRACD is a consequence of radiation treatment for various mediastinal tumors (breast, lung, lymphoma). It is the second most common cause of morbidity and mortality in patients treated with mediastinal radiation for cancer. While novel techniques decrease radiation exposure during cancer treatment, the incidence is expected to increase because of historical practices and delayed onset of symptoms. The prevalence of RACD is difficult to estimate given under-recognition. Additionally, most of the data comes from patients treated with radiation techniques from decades ago. In this discussion we review every nook and cranny of RACD to help guide you the next time you see a patient with a history of chest radiation.\n\n\n\nReview this CardioNerds Case Report of radiation associated cardiovascular disease for more: Episode #169. Chest pain in a Young Man \u2013 \u201cA Gray (Gy) Area\u201d \u2013 UC San Diego.\n\n\n\nAudio editing by\xa0CardioNerds Academy Intern,\xa0student doctor Yousif Arif. This episode is supported by a grant from Pfizer Inc.\n\n\n\nThis CardioNerds Cardio-Oncology series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs,\xa0Dr. Giselle Suero Abreu,\xa0Dr. Dinu Balanescu, and\xa0Dr. Teodora Donisan.\xa0\n\n\n\n\n\nPearls \u2022 Notes \u2022 References \u2022 Production Team\n\n\n\n\n\n\n\n\n\n\n\nCardioNerds Cardio-Oncology PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll\n\n\n\n\n\nCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!\n\n\n\n\n\n\n\n\n\nPearls and Quotes - Radiation-Associated cardiovascular disease\n\n\n\n\nDue to the legacy effect, the incidence of RACD will continue to increase in the next few years.\n\n\n\nWhen treating patients with a history of mediastinal radiation, we should remember to ask:\n\nHow much radiation was given?\n\n\n\nCould the heart have been exposed?\n\n\n\n\n\nRadiation can affect every part of the heart by causing coronary artery disease (CAD), valvulopathy, myocardial disease, conduction disease, and pericardial disease.\n\n\n\nExposure to ~25-30 Gy or more significantly increases the risk but RACD can occur at lower doses.\n\n\n\nTry to delay surgery as much as possible and do all you can in one operation to avoid re-operation in the future.\n\n\n\nFor revascularization, percutaneous coronary intervention (PCI) is typically preferred over coronary artery bypass grafting (CABG) but the choice should be individualized in consultation with a multidisciplinary heart team experienced in the management of RACD.\n\n\n\nIn general, for aortic valve disease, transcatheter replacement is recommended over surgical aortic valve replacement. For mitral valve disease, surgical replacement is recommended over repair. Every decision should be made with a heart team approach and made unique to that specific patient.\n\n\n\n\nShow notes - Radiation-Associated cardiovascular disease \n\n\n\nNotes were drafted by Dr. Patrick Azkarate.\n\n\n\n1. Understand the pathophysiology of RACD\n\n\n\n\nIonizing radiation has the potential to damage DNA. Both normal cells and cancer cells get damaged, but cancer has less effective DNA repair mechanisms and therefore malignant cells are more vulnerable to radiation therapy.\n\n\n\nAfter radiation causes acute damage, this sets off an inflammatory cascade leading to myofibroblast activation, fibrosis and collagen deposition, and subsequent stiffening of the myocardium and vessels.\n\n\n\n\n2. What may increase one\u2019s risk of developing RACD?\n\n\n\n\nYoung age (<50 years-old) at the time of radiation\n\n\n\nHigh cumulative dose (>30 Gy) or high dose of radiation fractions (>2 Gy/day)\n\n\n\nAnterior or left chest radiation (breast cancer, lung cancer, lymphoma)