Ischemic chest pain after 5-fluorouracil therapy for cancer

Baker, William P.; Dainer, Paul; Lester, Wanda M.; Marty, Aileen M.; Blair, Timothy P.

doi:10.1016/0002-9149(86)90788-5

Cited by 19 publications

(7 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As with our case, Patel et al [8] recently reported interval improvements in the left ventricular wall motion abnormalities in echocardiography performed 8 to 15 days following the initial study. Other investigators have reported similar reversible left ventricular dysfunction [9]. When cardiotoxicity occurs, 5-FU treatment is usually discontinued due to its very high recurrence rate (90%) [10].…”

Section: Discussionmentioning

confidence: 91%

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

Kim

Kwak

Lee

et al. 2012

Korean J Intern Med

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 91%

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

Kim

Kwak

Lee

et al. 2012

Korean J Intern Med

View full text Add to dashboard Cite

show abstract

“…It is active against solid tumours such as cancer of the breast, gastrointestinal tract, head and neck, and in recent years the intravenous use of high doses (1000 mg/m 2 ) has been widely employed. Besides the wellknown toxic effects of 5-FU, namely myelosuppression, mucositis, diarrhoea, nausea and vomiting, unexplained cardiotoxicity has been observed (Anderson et al, 1993;Baker et al, 1986;De Forni et al, 1992;Freeman & Costanza, 1988;Misset et al, 1990;Robben et al, 1993). The incidence of cardiotoxicity ranges from 1% (Anderson et al, 1993) to 18% (Cwikiel et al, 1995) and probably depends on the dose and rate of 5-FU administration.…”

mentioning

confidence: 99%

The anti‐neoplastic drug 5‐fluorouracil produces echinocytosis and affects blood rheology

Baerlocher¹,

Beer²,

Owen³

et al. 1997

Br J Haematol

View full text Add to dashboard Cite

Summary. The anti-neoplastic agent 5-fluorouracil (5-FU) in high therapeutic doses can induce angina pectoris and myocardial infarction. The pathophysiological mechanism of this side-effect has not yet been elucidated. We analysed the influence of 5-FU on blood rheology in vitro. Whole blood, blood cell suspensions and plasma were incubated with increasing concentrations of 5-FU (final concentrations 0, 0 . 08, 0 . 4, 2, 10 and 25 mg/ml 5-FU) at 37ЊC. Erythrocyte morphology was analysed after fixation with glutaraldehyde. Viscosity was measured at high and low shear rates (94 and 0 . 1 s -1 ). Erythrocyte aggregation and the cell transit times of erythrocytes through 5 mm pores and polymorphonuclear leucocytes through 8 mm pores were determined. 5-FU induced a dose-dependent formation of echinocytes within minutes and was reversible upon removal of 5-FU, which reflected a preferential intercalation of the drug in the outer hemileaflet of the cell membrane. High shear blood viscosity was increased at the highest 5-FU concentration (148 Ϯ 12%), and at low shear rate a dose-dependent decrease was found (0 mg/ml: 100%, 0 . 08 mg/ml: 87 Ϯ 10%, 0 . 4 mg/ml: 80 Ϯ 19%, 2 mg/ml: 70 Ϯ 15%, 10 mg/ml: 40 Ϯ 19%, 25 mg/ml: 33 Ϯ 5%). Erythrocyte aggregation was decreased by the 5-FU-induced echinocytosis. The transit time of erythrocytes through narrow pores was increased in a dose-dependent manner by 5-FU, whereas the transit time of polymorphonuclear leucocytes was initially decreased at 10 mg/ml and returned to control after 60 min incubation. We conclude that 5-FU interacts with the cell membrane, induces echinocytosis and vesiculation and affects blood rheology in several ways which may contribute to cardiovascular complications.

show abstract

“…5 -Fluorouracil may cause myocardial ischemia or chest pain owing to coronary artery spasm (Baker et al 1986 ).…”

Section: Cancer Chemotherapeutic Agentsmentioning

confidence: 99%