Coronary Vasospasm Secondary to 5-Fluorouracil and Its Management: Case Report

Abstract

Although rare, 5-fl uorouracil (5-FU) may lead to cardiotoxicity that presents with angina, elevated cardiac enzymes and electrocardiogram (ECG) changes. Coronary vasospasm related to 5-FU is a rare clinical entity in oncological practice and may be seen during both bolus and protracted infusional administration. This toxicity is generally reversible and responds well to conventional anti-angina treatment following discontinuation of infusion. We propose that parenteral diltiazem is an eff ective and safe approach for the treatment of coronary vasospasm secondary to 5-FU infusion. We present clinical fi ndings and management of a case in which coronary vasospasm occurred during the infusion of the 5-FU component of FOLF-IRI-bevacizumab chemotherapy (CT) regimen given for treatment of metastatic rectal cancer. Key Words: 5-fl uorouracil, Coronary vasospasm, Diltiazem ÖzetAz görülmesine rağmen; 5-Flourourasil, (5-FU) EKG değişiklikleri, kardiyak enzim yüksekliği ve anjina ile kendini gösteren kardiyotoksisiteye yol açabilmektedir. 5-FU ile ilişkili koroner vazospazm onkoloji pratiğinde nadir bir klinik durumdur ve hem bolus hem de intravenöz infüzyon tedavisi esnasında karşılaşılabilir. Bu toksisite genellikle geri dönüşümlüdür ve infüzyonun durdurulması sonrası uygulanan anti-anjinal tedaviye iyi yanıt vermektedir. Bizce, panrenteral diltiazem, infüzyonel 5-FU'ya bağlı koroner vazospazmın tedavisinde etkili ve güvenli bir yaklaşımdır. Yazımızda, metastatik rektum kanseri tanısıyla FOLFIRI-Bevasizumab kemoterapi rejiminin bir bileşeni olarak verilen 5-FU infüzyonu sırasında koroner vazospazm geçiren bir vakanın klinik bulguları ve yönetimi sunulmaktadır.

Reversible Systolic Heart Failure in a Patient on Ibrutinib Chemotherapy

“…Cardiotoxicity due to chemotherapeutic drugs has been an evolving field, with a lot of interest generated lately due to the introduction of a large number of chemotherapeutic agents such as monoclonal antibodies and small-molecule inhibitors. While some of these agents affect the heart directly by causing vasospasm (5-fluorouracil) [ 5 ], free radical injury (anthracyclines), or intracellular signaling pathway alteration (sunitinib, trastuzumab), others can affect indirectly via the development of hypertension (bevacizumab, ibrutinib) and arrhythmias [ 6 , 7 ]. In contradiction to monoclonal antibodies (ending with “mab”) such as trastuzumab which affect the intracellular signaling pathways by attaching outside of the cells, the small-molecule inhibitors (ending with “nib”) affect these pathways by reaching into the cell and altering the interplay of molecules.…”

The Role of Vasospasm and Microcirculatory Dysfunction in Fluoropyrimidine-Induced Ischemic Heart Disease

“…Focal coronary artery spasm can be effectively treated by CCBs and nitrates [ 43 , 46 , 47 , 48 , 86 ]. The renin–angiotensin system inhibitors may prove to be useful in long-term management as well.…”