Irradiation of the heart in patients with breast cancer increases the risk of the so-called “radiation-induced heart disease” (RIHD). Among risk factors of RIHD, overweight, hypertension and diabetes mellitus take a major place.

To describe a clinical case of an obese hypertensive diabetes mellitus woman with breast cancer since the begining of her radiotherapy until heart failure on the basis of the report from the European Association of Cardiovascular Imaging consensus for evaluation of cardiovascular complications of radiotherapy in adults.

A 67 years old woman came to the emergency room with recent worsening of breathlessness. She has had uncontrolled hypertension since 27 years, diabetes mellitus since 17 years and obesity (31kg/m²). She had a complex past medical history. In 1997th she has had breast cancer followed by surgery and radiotherapy with a high cumulative dose of 50 Gy. At this time she was in complete remission. Ten years after, she developed coronary artery disease with subsequent coronary artery bypass surgery. Then she underwent mechanical aortic valve replacement related to mixed aortic valve disease followed by monochamber device for syncopal complete heart block. Few months later she developed heart failure despite upgrading her device to two chambers device. Physical examination: BP/HR: 120/70mmHg/70bpm under medical therapy. Shortness of breath (NYHA class III). Heart: Systolic murmur was audible over the mitral area and substitute sounds of her prosthetic aortic valve. The patient was taking ramipril 5mg daily, furosemide 80 mg daily, spironolactone 25mg daily, warfarin with an international normalized ratio (INR) between 3 and 4; rosuvastatin 20mg daily and beta blockers that was given previously had to be stopped for occurrence of heart failure. Echocardiography: leaflet calcifications on the mitral valve with a mixed lesion; good function of her bileaflet mechanical aortic valve. Depressed left systolic function and markedly elevated pulmonary artery pressure.

After control of her risks factors and optimizing her medical therapy, patient felt much better after two weeks with decreasing of her pulmonary artery pressure. We follow her data closely.

This case suggests that patients with classical cardiovascular risk factors must be treated in a meticulous way in collaboration with oncologist and radiotherapist. Modifying risk factors as well as early detection and treatment of RIHD may improve the long-term cardiovascular outcome.