Acute Cardiogenic Shock Induced by Infusional 5-Fluorouracil

Abstract

A 49-year-old patient with metastatic carcinoma of the bladder and no prior history of heart disease presented with diffuse ST elevation, elevated troponins, and biventricular dysfunction requiring intensive care unit admission and inotropic support after receiving her first course of infusional 5-fluorouracil (5-FU). Over the course of several days, the patient's cardiac function and clinical status returned to baseline. A follow-up echocardiogram performed 5 days after initial presentation revealed an ejection fraction of 59 percent, with no evidence of wall motion abnormalities. Subsequent 5-FU chemotherapy was discontinued, and the patient went on to receive second-line chemotherapy.

Dietary Glycine Prevents FOLFOX Chemotherapy-Induced Heart Injury: A Colorectal Cancer Liver Metastasis Treatment Model in Rats

“…Besides the FOLFOX-induced pathologic changes in the myocardial tissue, impaired LV function was detected and the decrease of LVEF after FOLFOX correlated to h-FABP level and myocardial fibrosis. These results are in accordance with several recent preclinical studies, which also showed an increased level of apoptosis, myocardial fibrosis, and decreased LVEF after treatment with anthracycline-based chemotherapy [35][36][37][38] and with the series of reports that showed reduced LVEF following 5-FU-based chemotherapy in humans [39][40][41][42][43].…”

5-Fluorouracil–Associated Cardiogenic Shock

“…In some patient, the main presentation was an acute coronary syndrome, so the acute cardiac dysfunction was believed to be secondary to coronary vasoconstriction. 9,10 Our patient did not have any evidence of vasoconstriction on a left heart catheterization procedure and was an unlikely cause. In other studies, some have hypothesized that myocardial depression could be related to uncoupling of electromechanical myocardial function, likely at the level of ATP generation.…”

“…Laboratory studies were significant for an elevated blood urea nitrogen of 88 mg/dL, creatinine of 2.9 mg/dL (0.8–1.2 mg/dL), and anion gap of 18. 8–12 Initial electrocardiogram and troponin came back within normal limits. Complete blood count showed a normal hemoglobin level, white blood count, and platelet level.…”