Korean J Intern Med.  2012 Sep;27(3):342-345. 10.3904/kjim.2012.27.3.342.

A Case of Severe Coronary Spasm Associated with 5-Fluorouracil Chemotherapy

Affiliations
  • 1Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea.
  • 2Department of Internal Medicine, Cardiovascular Center, National Medical Center, Seoul, Korea. seo0515@medimail.co.kr

Abstract

Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.

Keyword

Fluorouracil; Coronary vasospasm; Calcium channel blockers; Angina pectoris

MeSH Terms

Aged, 80 and over
Angina Pectoris/chemically induced
Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*adverse effects
Calcium Channel Blockers/administration & dosage
Colonic Neoplasms/*drug therapy
Coronary Angiography
Coronary Vasospasm/*chemically induced/diagnosis/therapy
Drug-Eluting Stents
Electrocardiography
Fluorouracil/administration & dosage/*adverse effects
Humans
Leucovorin/administration & dosage/adverse effects
Male
Nifedipine/administration & dosage
Nitroglycerin/administration & dosage
Organoplatinum Compounds/administration & dosage/adverse effects
Percutaneous Coronary Intervention/instrumentation
Recurrence
Severity of Illness Index
Treatment Outcome
Vasodilator Agents/administration & dosage
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