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Quiz {#650
  -id: 115
  -titre: "Douleur thoracique, Comment investir en cardio-oncolgie?"
  -titreEn: "Chest pain, how to investigate in cardio-oncolgy?"
  -type: "Cardio-oncologie"
  -typeEn: "Cardio-oncology"
  -auteur: "Dr Sarra CHENIK, Dr Ghassen Tlili"
  -service: "<p>Service de Cardiologie, Hopital Militaire de Tunis</p>"
  -serviceEn: "<p>Cardiology department, Military hospital of tunis</p>"
  -photoAuteur: "b1ed0c79f7db6f82687afc83591bbdd8.jpeg"
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  -commentaire: """
    <p>Pont intra myocardique de l’interventriculaire antérieur<br><iframe width="100%" height="300px" src="https://www.youtube.com/embed/XTbzcxdQEDU" title="Cas du mois cardio-oncologie - avril 2023- Dr sarra chenik &amp; Dr Ghassen Tlili" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen></iframe></p><p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><span style="background-color:white"><span style="color:#212121">Le pont myocardique peut engendrer un syndrome coronarien aigu (SCA) par vasospasme ou &agrave; ath&eacute;roscl&eacute;rose en amont de l&rsquo;art&egrave;re tunnellis&eacute;e (1). Les patients canc&eacute;reux repr&eacute;sentent un groupe &agrave; risque particuli&egrave;rement &eacute;lev&eacute; par rapport aux patients non canc&eacute;reux pr&eacute;sentant un SCA. Par ailleurs, Les taxanes induisent une isch&eacute;mie myocardique par vasospasme coronarien (2). D&#39;autre part, l&#39;irradiation du thorax et la chimioth&eacute;rapie peuvent entra&icirc;ner une maladie coronarienne pr&eacute;coce due &agrave; une ath&eacute;roscl&eacute;rose acc&eacute;l&eacute;r&eacute;e ou &agrave; une hyperplasie fibro-intimale (3,4). D&rsquo;une mani&egrave;re g&eacute;n&eacute;rale, le traitement anticanc&eacute;reux doit &ecirc;tre temporairement interrompu et une approche multidisciplinaire urgente est indiqu&eacute;e pour planifier une prise en charge individualis&eacute;e bas&eacute;e sur des lignes directrices, en tenant compte de l&#39;&eacute;tat du cancer, du pronostic et des pr&eacute;f&eacute;rences du patient concernant la prise en charge invasive (5).</span></span></span></span></p>\n
    \n
    <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><span style="background-color:white"><span style="color:#212121">R</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;">eferences: </span></span></p>\n
    \n
    <ol>\n
    \t<li style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;">Andrea Santucci&nbsp; 1 , Francesca Jacoangeli&nbsp; 1 , Sara Cavallini&nbsp; 1 , Matteo d&#39;Ammando&nbsp; 1 , Francesca de Angelis&nbsp; 1 , Claudio Cavallini. The myocardial bridge: incidence, diagnosis, and prognosis of a pathology of uncertain clinical significanceEur Heart J Suppl. 2022. 12;24(Suppl I):I61-I67.</span></span></li>\n
    \t<li style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;">Shah K, Gupta S, Ghosh J, Bajpai J, Maheshwai A. Acute non-ST elevation myocardial infarction following paclitaxel administration for ovarian carcinoma: a case report and review of literature. J Cancer Res Ther. 2012;8:442&ndash;4.</span></span></li>\n
    \t<li style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;">Beata W, Rafał S, Stanisław B, Piotr B. [Radiotherapy and chemotherapy for oncological diseases--unappreciated risk factors for coronary artery disease? Acute coronary syndrome in 3 women after radiotherapy and chemotherapy--case reports]. Kardiol Pol. 2008;66(4):415-9.</span></span></li>\n
    \t<li style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;">Cuomo J, Javaheri S, Sharma G, Kapoor D. How to prevent and manage radiation-induced coronary artery disease. Heart. 2018;104(20):1647-1653</span></span></li>\n
    \t<li style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,&quot;sans-serif&quot;"><span style="color:#212121">2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS).</span> <span style="color:#212121">Eur Heart J. 2022;43(41):4229-4361.</span></span></span></span></li>\n
    </ol>
    """
  -commentaireEn: """
    <p>Myocardial bridge of interventricular anterior coronary <br><iframe width="100%" height="300px" src="https://www.youtube.com/embed/XTbzcxdQEDU" title="Cas du mois cardio-oncologie - avril 2023- Dr sarra chenik &amp; Dr Ghassen Tlili" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen></iframe></p><p>Myocardial bridge (MB) is associated with the acute coronary syndrome (ACS) with a mechanism linked to vasospasm or atherosclerosis upstream of the tunnelled tract. However, the majority of people with MB-related ACS experience unstable angina (troponin negative) rather than myocardial infarction (1). Cancer patients with ACS represent a particularly high- risk group compared with non-cancer patients with ACS. Additionally, many cancer treatments including chemotherapy and radiation therapy increase the risk of ACS, and ultimately these patients have a very high mortality rate.</p>\n
    \n
    <p>the taxanes induces myocardial ischemia through coronary vasospasm (2) in the other hand, Chest irradiation and chemotherapy may lead to precocious coronary artery disease due to accelerated atherosclerosis or fibro intimal hyperplasia (3,4). Cancer treatment should be temporarily interrupted, and an urgent multidisciplinary approach is indicated to plan an individualized guideline-based management, taking into account cancer status, prognosis, and the patient&rsquo;s preferences regarding invasive management (5).</p>\n
    \n
    <p>References:<br />\n
    1. Andrea Santucci 1 , Francesca Jacoangeli 1 , Sara Cavallini 1 , Matteo d'Ammando<br />\n
    1 , Francesca de Angelis 1 , Claudio Cavallini. The myocardial bridge: incidence, diagnosis, and prognosis of a pathology of uncertain clinical significanceEur Heart J Suppl. 2022. 12;24(Suppl I):I61-I67.<br />\n
    2. Shah K, Gupta S, Ghosh J, Bajpai J, Maheshwai A. Acute non-ST elevation myocardial infarction following paclitaxel administration for ovarian carcinoma: a case report and review of literature. J Cancer Res Ther. 2012;8:442&ndash;4.<br />\n
    3. Beata W, Rafał S, Stanisław B, Piotr B. [Radiotherapy and chemotherapy for oncological diseases--unappreciated risk factors for coronary artery disease? Acute coronary syndrome in 3 women after radiotherapy and chemotherapy--case\n
    reports]. Kardiol Pol. 2008;66(4):415-9.<br />\n
    4. Cuomo J, Javaheri S, Sharma G, Kapoor D. How to prevent and manage radiation- induced coronary artery disease. Heart. 2018;104(20):1647-1653<br />\n
    5. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC- OS). Eur Heart J. 2022;43(41):4229-4361.</p>
    """
  -description: """
    <p style="text-align:justify">Une femme &acirc;g&eacute;e de 60 ans se pr&eacute;sente &agrave; l&#39;unit&eacute; de cardio-oncologie pour douleur thoracique d&#39;apparition r&eacute;cente. La patiente a des ant&eacute;c&eacute;dents d&#39;hypertension art&eacute;rielle et de carcinome canalaire invasif du sein gauche. Au moment du diagnostic, elle a subi une mastectomie, suivie d&#39;une chimioth&eacute;rapie adjuvante pendant 18 semaines avec de l&#39;&eacute;pirubicine &agrave; 270 mg/m&sup2;, des taxanes &agrave; 765 mg/m&sup2; et de l&#39;herceptine &agrave; 765mg/m&sup2;. Lors de l&#39;examen cardiaque initial, la patiente &eacute;tait normotendue &agrave; 130/70 mmHg, la fr&eacute;quence cardiaque &eacute;tait de 95 battements par minute, les bruits du c&oelig;ur &eacute;taient normaux, sans galop ni souffle. L&#39;&eacute;lectrocardiogramme &agrave; 12 d&eacute;rivations a r&eacute;v&eacute;l&eacute; des modifications dynamiques des ondes T dans les d&eacute;rivations apicolat&eacute;rales [figure 1], son &eacute;lectrocardiogramme de base &eacute;tait normal [figure 2].<br />\r\n
    L&#39;&eacute;chocardiographie a r&eacute;v&eacute;l&eacute; une fraction d&#39;&eacute;jection normale (60 %), mais une alt&eacute;ration de la d&eacute;formation longitudinale du ventricule gauche &agrave; 13,8 % avec une cin&eacute;tique homog&egrave;ne. Le taux de troponine I &eacute;tait normal &agrave; 1 ng/ml. Comment explorer cette patiente ?</p>
    """
  -descriptionEn: "<p style="text-align:justify">A 60 year old female presents to the cardio-oncology unit complaining of new onset chest pain. The patient has a history of hypertension and stage 2 invasive ductal carcinoma of the left breast. At the time of diagnosis, she was treated with mastectomy 14&nbsp;months before presentation, followed by adjuvant chemotherapy for 18&nbsp;weeks with epirubicine at 270mg/m&sup2;, taxanes at 765mg/m&sup2; and herceptine at 765mg/m&sup2;.There is no report of premature heart disease in her family. On initial cardiac examination, patient was normotensive to 130/70&nbsp;&nbsp;mmHg, heart rate 95 beats per minute, normal heart sounds without gallop or murmurs. 12-lead electrocardiogram&nbsp;(EKG) revealed dynamic T waves changes in apicolateral leads [Figure&nbsp;1], her EKG at baseline was normal[Figure&nbsp;2] . Echocardiogram revealed a normal ejection fraction (60%) but an altered longitudinal left ventricular strain at 13.8% and a normal wall motion.</p>"
  -casdemois: Casdemois {#477 …}
  #question: PersistentCollection {#608 …}
  #media: PersistentCollection {#673 …}
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