Non-ST elevation myocardial infarction and ischaemic cardiomyopathy due to extrinsic tumour compression of left internal mammary artery graft-obtuse marginal with fibrosis due to chest wall radiation: a case report

Background: Cardiovascular disease and cancer remain the most prevalent conditions worldwide. The relationship between the two is becoming increasingly recognized, with both sharing similar risk factors. Currently, there are no guidelines or substantial data for the management of this subset of patients. This case presents the management of a patient with advanced malignancy and ischaemic cardiomyopathy, exploring the difficult decision making process for revascularization, ensuring an individualized approach is used for each patient. Case summary: A 68-year-old man with Stage II lung cancer and overall poor prognosis with multiple comorbidities limiting his functional status presented with a non-ST elevation myocardial infarction and ischaemic cardiomyopathy due to extrinsic tumour compression and left internal mammary artery graft-obtuse marginal fibrosis due to chest wall radiation. He had a prolonged admission with the heart team discussions regarding optimal management. He subsequently underwent percutaneous coronary intervention to his native left circumflex chronic total occlusion. He was discharged home on dual antiplatelet and heart failure therapy. Discussion: This case reflects that the management of patients with cancer and coronary artery disease is complex. Many factors including patient comorbidities adversely impact on prognosis, and treatment goals need to be clearly defined. The evidence in the area is lacking but continues to grow; however, the care for such patients needs to be individualized.