Cardiovascular effects of radiation therapy: practical approach to radiation therapy-induced heart disease.
Cardiovascular effects of radiation therapy: practical approach to radiation therapy-induced heart disease.
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DOI：
10.1097/01.crd.0000131188.41589.c5
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发表时间：
2005-03-01
影响因子：
2.1
通讯作者：
Mallik, Rajiv
中科院分区：
文献类型：
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作者：
Lee, Peter J;Mallik, Rajiv
随着更多接受放射治疗的患者在各种恶性肿瘤的治疗下存活下来，放射性心脏病(RIHD)越来越被人们所认识。辐射影响心脏的每一个组成部分，从亚临床组织病理变化到显性临床疾病。心包受累最常见，包括无症状心包积液和缩窄性心包炎。涉及心肌、瓣膜装置和传导系统的疾病通常是亚临床的。当出现症状时，它们通常是更致命但可治疗的辐射诱发冠状动脉疾病(CAD)的先兆。现代辐射传输系统的改进已将对心脏的辐射降至最低。然而，随着胸部各种恶性肿瘤放射治疗适应证的增加和不断涌现，作为骨髓移植的一部分，以及作为晚期既往冠心病近距离放射治疗的主要手段，RIHD的发生率可能会增加。对RIHD的适当治疗，无论是显性的还是隐性的，都必须包括了解RIHD的自然病史，通过仔细的病史识别症状，并警惕地寻找RIHD或其他可能模拟RIHD的疾病的可治疗原因。本文侧重于为普通内科和心脏病学实践提供实用而全面的临床信息。
Radiation induced heart diseases (RIHD) are increasingly recognized as more patients who received radiation therapy survive their diseases with improved management of various malignancies. Radiation affects every component of the heart, ranging from subclinical histopathologic changes to overt clinical disease. Pericardial involvement is the most common and includes asymptomatic pericardial effusion and constrictive pericarditis. The diseases involving the myocardium, valvular apparatus, and conduction system are often subclinical. When symptomatic, they are often the harbinger of more lethal, but treatable, radiation-induced coronary artery disease (CAD). Improvements in the modern radiation delivery systems have minimized irradiation of the heart. However, with increased and emerging indications for radiation therapy for various malignancies in the chest, as a part of bone marrow transplantations, and as the main agent of brachytherapy for advanced preexisting CAD, the incidence of RIHD is likely to increase. Appropriate management of RIHD, either overt or occult, must include understanding the natural history of RIHD, recognition of symptoms by careful history, and vigilant search for treatable causes of the RIHD or other diseases that might mimic RIHD. This article focuses on providing practical yet comprehensive clinical information for general internal medicine and cardiology practices.