A 43-year-old man is evaluated because of crushing substernal chest pain that developed during a pickup basketball game with colleagues at work. He was treated 15 years ago for stage IIB massive mediastinal Hodgkin"s disease. Treatment included doxorubicin, bleomycin, vinbiastine, and dacarbazine (ABVD) followed by mantle-field radiation therapy to a total dose of 4400 cGy. He has had no recurrence of his Hodgkin"s disease. He takes thyroid medication because he developed hypothyroidism 2 years after completing his therapy for Hodgkins disease. What is the most likely diagnosis?
A)Recurrent Hodgkins disease
B)Myocardial infarction
C)Pulmonary fibrosis
D)Anemia associated with secondary myelodysplasia evolving to acute leukemia
E)Constrictive pericarditis

Question

Quizplus · Accepted Answer

The most likely diagnosis for a 43-year-old man presenting with crushing substernal chest pain during physical activity, who has a history of treatment for Hodgkin's disease that included doxorubicin (a known cardiotoxic agent) and mantle-field radiation therapy (which can cause coronary artery disease), is myocardial infarction.

A 43-Year-Old Man Is Evaluated Because of Crushing Substernal Chest