Research Day

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While radiation and chemotherapy have achieved high rates of cure for Hodgkin lymphoma, the medical community is only now starting to characterize the long-term effects of treatment on these young cancer survivors, many decades later. Mantle radiation has been implicated in significantly increased cardiovascular risks, pulmonary fibrosis, other cancers, and thyroid disease over the patient’s lifetime. However, new syndromes are still being discovered within this population as they age. The purpose of this case study was to consider the unique health issues of cancer survivors, and how their treatment history should prompt us to broaden our differentials. Our patient presented emergently with what seemed like classic unstable angina and heart failure, which were already being treated by outside physicians, despite a plethora of puzzling diagnostic evidence to the contrary. She also carried a diagnosis of postural orthostatic tachycardia syndrome (POTS) after what was interpreted to be a positive tilt table test earlier that year. After careful research and complete reconsideration of her diagnostic findings over the year, it was discovered that an unusual syndrome of autonomic dysfunction has been recently characterized within this population, distinct from any issues of cardiac dysfunction, and would explain her episodes of autonomic instability. Specialized long-term follow up with providers knowledgeable about the issues of cancer survivors may be ideal to maintain optimal functional status in this population. Additionally, a search for medications to prevent the gradual progression of fibrosis from radiation therapy may become relevant as more people survive cancer diagnoses.



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