Direct Consequences of Tumor

Pericardial and myocardial metastases

Large vessel obstruction

Pulmonary tumor emboli

Indirect Consequences of Tumor (Complications of Circulating Mediators)

Nonbacterial thrombotic endocarditis (NBTE)

Carcinoid heart disease

Pheochromocytoma-associated heart disease

Myeloma-associated amyloidosis

Effects of Tumor Therapy

Chemotherapy

Radiation therapy

Modified from Schoen, FJ, et al: Cardiac effects of non-cardiac neoplasms. Cardiol Clin 2:657, 1984.

compliance. Bronchogenic carcinoma or malignant lymphoma may infiltrate the mediastinum extensively, causing encasement, compression, or invasion of the superior vena cava with

resultant obstruction to blood coming from the head and upper extremities (superior vena cava syndrome). Renal cell carcinoma, because of its high propensity to invade the renal vein, can

grow in the lumen of the renal vein into and along the inferior vena cava and can, occasionally, extend into the right atrium, blocking venous return to the heart.

Noncardiac tumors cause indirect cardiac effects, sometimes via circulating tumor-derived substances (e.g., NBTE [see earlier], carcinoid heart disease, pheochromocytoma-associated

myocardial damage, multiple myeloma-derived immunoglobulin-causing amyloidosis). Complications of chemotherapy were discussed earlier in this chapter. Radiation used to treat

breast, lung, or mediastinal neoplasms can cause pericarditis, pericardial effusion, myocardial fibrosis, and chronic pericardial disorders. Other cardiac effects of radiotherapy include

accelerated coronary artery disease and mural and valvular endocardial fibrosis.

Cardiac Transplantation

Transplantation of cardiac allografts is now frequently performed (approximately 3000 per year worldwide) for severe, intractable heart failure of diverse causes, the two most common of

which are DCM and IHD. Three major factors contribute to the widespread success of cardiac transplantation since the first successful human to human transplant in 1967: (1) careful

selection of candidates, (2) improved

Figure 12-39Complications of heart transplantation. A, Cardiac allograft rejection typified by lymphocytic infiltrate, with associated damage to cardiac myocytes. B, Graft coronary

arteriosclerosis, demonstrating severe diffuse concentric intimal thickening producing critical stenosis. The internal elastic lamina (arrow) and media are intact (Movat pentachrome stain,

elastin black). (B, reproduced by permission from Salomon RN, et al: Human coronary transplantation-associated arteriosclerosis. Evidence for chronic immune reaction to activated graft

endothelial cells. Am J Pathol 138:791, 1991.)

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