Myocardial bridge in a patient with castration-resistant metastatic prostate cancer treated with enzalutamide.
Giordano. Giulia G; Mastrantoni. Luca L; Colloca. Giuseppe Ferdinando GF
Key Findings
- The patient had a myocardial bridge but normal troponin and no acute ischemia despite chest pain.
- Adding ranolazine (an anti‑anginal) and simvastatin allowed continuation of enzalutamide and triptorelin without worsening heart issues.
- Regular cardiac imaging and multidisciplinary review helped maintain cancer treatment safely in an elderly, high‑risk patient.
Practical Outcomes
- If you’re using triptorelin or other androgen‑blocking agents, keep an eye on heart health, especially in older adults. If a myocardial bridge or mild ischemic signs appear, consider anti‑anginal meds like ranolazine and a statin, and don’t automatically stop the cancer therapy. Regular check‑ups with a cardiologist can help balance cancer control and heart safety.
Summary
An 88‑year‑old man with advanced prostate cancer was on enzalutamide, denosumab and the peptide drug triptorelin when he developed chest pain. Tests showed a myocardial bridge (a heart artery that runs under heart muscle) but no heart attack. Doctors added ranolazine and a statin, kept the cancer drugs, and his heart stayed stable during follow‑up. This suggests that with careful cardiac monitoring, you can continue androgen‑blocking therapy even in older patients with some heart anomalies.
Abstract
Myocardial bridge is a morphological anomaly of the heart characterised by the presence of a myocardial segment above a coronary artery, which results in a higher risk of cardiovascular events. In patients with prostate cancer treated with androgen receptor-targeted agents, a higher risk of cardiotoxicity was observed. An 88 years old man with metastatic castration-resistant prostate cancer in treatment with enzalutamide, denosumab, and triptorelin presented to our attention complaining dyspnoea and angina pectoris. Blood examinations revealed normal Troponin I levels. Transthoracic echocardiography revealed no signs of acute myocardial ischaemia. The treadmill stress test revealed S-T tract under levelling in V4-V6 with a very slow resolution. Coronary angiography identified a myocardial bridge in the medium tract of the interventricular anterior artery. Due to these findings, ranolazine and simvastatin were started and, after multidisciplinary assessment, we decided to continue the treatment with enzalutamide. At the first follow-up visit echocardiography found out the cardiological reports stability and no therapy changes were performed. During follow-up visit cardiological revaluation showed reports stability and no therapy changes were performed. Due to the high prevalence of prostate cancer in elderly patients at high cardiovascular risk and the increasing use of androgen receptor-targeted agent, a multidisciplinary approach is highly recommended to weigh survival benefits on toxicities. This case report may support the use of androgen receptor-targeted agent in elderly patients with controlled cardiovascular diseases, a population that is often excluded from randomised trials.
Study Information
pubmed
2023
2023-06-06T00:00:00.000Z
10.1177/10781552231180599
2
9