5-Fluorouracil-induced coronary vasospasm

Abstract

Cardiotoxicity due to 5-fluorouracil involves rare and life-threatening cardiotoxic events occurring in less than 1% of the patients. We describe a case of coronary vasospasm due to parenteral 5-fluorouracil, which did not recur with oral capecitabine. We also give a brief review of the cardiotoxicity of 5-fluorouracil, its treatment and prevention.

Mechanisms of Coronary Artery Spasm

“…Furthermore, it is known that the consumption or abuse of several other substances (eg, cocaine, amphetamines, marijuana, 5-fluorouracil, capecitabine, sumatriptan, etc) can provoke or favor CAS. [57][58][59][60] …”

Chemotherapy-induced cardiomyopathy

“…In patients with known coronary artery disease treatment with aspirin, b-blockers and HMG-CoA reductase inhibitors should be continued and may be beneficial. Prophylactic vasodilators (nitrates and calcium channel blockers) are sometimes used when re-challenging with a drug that produced ischemia, and may allow therapy to be continued [99]. Precipitating conditions, such as acute coronary syndrome, should be treated aggressively as a survival benefit of aspirin therapy in this condition extends even to patients with thrombocytopenia [119].…”

“…The exact underlying mechanism of 5-FU-induced cardiotoxicity has not been clearly defined and is multifactorial [96]. One postulated mechanism of 5-FU-induced cardio toxicity is coronary vasospasm [99]. Calcium channel blockers and/or nitrates may be protective against the development of ischemia with 5-FU therapy.…”

Atheroma and Coronary Artery Spasm

“…3 In general, coronary spasm could occur either spontaneously [1][2][3] or after exposure to various active substances such as cocaine, marijuana, amphetamine, alcohol, anti-migraine, chemotherapeutic agents and antibiotics. [4][5][6][7][8] During coronary intervention, vasospasm was found in 1-5% 9 and, on rare occasions, has led to cardiogenic shock. 10 Currently, spontaneous coronary vasospasm is widely recognized as a potential cause of acute coronary syndrome (ACS) i.e.…”