Angina Pectoris und ST-Hebungen nach Chemotherapie mit 5-FU

Abstract

We report on the case of a 64 year old male who received chemotherapy for a metastatic squamous cell carcinoma of the oropharynx. The chemotherapeutic regimen consisted of 5-fluorouracil (5-FU) and cisplatin. Six hours after completion of the first 24 h continuous infusion of 5-FU, the patient developed severe chest pain accompanied by vegetative symptoms and a pronounced ST-elevation of the precordial leads. Under the suspicion of an acute anterior myocardial infarction an immediate coronary angiogram was performed, demonstrating a total occlusion of the left anterior descending (LAD) coronary artery close to the left main stem. The other coronary arteries appeared smooth. After the intracoronary administration of nitroglycerine, the LAD reopened spontaneously without any residual stenosis, paralleled by complete relief of all symptoms. Therefore, 5-FU induced coronary spasm was diagnosed. After initial therapy with intravenous nitrate followed by oral calcium channel blocker, the patient remained free of symptoms and no rise in cardiac enzymes were noted. The chemotherapeutic regimen was changed to cisplatin plus docetaxel. No new attacks of chest pain occurred and the antivasospastic therapy could be stopped without further events.

5-fluorouracil and cardiotoxicity: a review

“… 72 , 73 Amongst patients suspected of having 5-FU-related cardiotoxicity, vasospasm was not demonstrated on pharmacologic provocation with the alkaloid ergonovine, 74 an agent that has previously been used to assess coronary vasomotor function through its action on smooth muscle serotonergic receptors, which in turn leads to muscle contraction and vasoconstriction under physiologic conditions. 75 Furthermore, in one study of patients who reported angina in response to a 5-FU challenge who had ECG changes suggestive of ischemia, those who underwent concurrent echocardiography were shown to have global akinesia, incompatible with a characteristic territorial distribution of a major coronary artery. 5 Despite the systemic distribution of 5-FU, multivessel coronary vasospasm is uncommon in patients receiving 5-FU.…”

Oxaliplatin-Induced Acute ST Segment Elevation Mimicking Myocardial Infarction: A Case Report

“…The patient suffered from 2-vessel coronary artery disease and was treated with PCI and implantation of 2 drug-eluting stents following left heart catheterization [6]. In contrast, after systemic chemotherapy with intravenous 5-FU, a 64-year-old male patient developed typical angina pectoris with ST segment elevations in V1-V4 but without any increase in cardiac enzymes, as reported by Spencker et al [9]. The most likely cause was a complete vasospasm of the LAD coronary artery with consecutive complete occlusion of the vessel, which diminished after intracoronary administration of nitroglycerin (0.2 mg) [9].…”

“…In contrast, after systemic chemotherapy with intravenous 5-FU, a 64-year-old male patient developed typical angina pectoris with ST segment elevations in V1-V4 but without any increase in cardiac enzymes, as reported by Spencker et al [9]. The most likely cause was a complete vasospasm of the LAD coronary artery with consecutive complete occlusion of the vessel, which diminished after intracoronary administration of nitroglycerin (0.2 mg) [9]. For oxaliplatin, which was used in the present patient, data on events mimicking acute coronary syndromes are rare.…”

Kounis syndrome in a patient with ovarian cancer and allergy to iodinated contrast media: Report of a case

“…Cancer chemotherapy has also been associated with vasospastic angina [28][29][30][31][32][33]. Indeed our patient, who had previously been reported allergic to iodinated contrast media, developed allergic angina and coronary vasospasm after therapy with cisplatin and cyclophosphamide.…”