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Case Reports
. 2012 Sep;27(3):342-5.
doi: 10.3904/kjim.2012.27.3.342. Epub 2012 Sep 1.

A case of severe coronary spasm associated with 5-fluorouracil chemotherapy

Sang-Min Kim  1 , Cheol-Hoon Kwak, Bora Lee, Seong Beom Kim, Jung-Ju Sir, Wook-Hyun Cho, Suk-Koo Choi
Affiliations
Case Reports

A case of severe coronary spasm associated with 5-fluorouracil chemotherapy

Sang-Min Kim et al. Korean J Intern Med. 2012 Sep.

Abstract

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.

Keywords: Angina pectoris; Calcium channel blockers; Coronary vasospasm; Fluorouracil.

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Conflict of interest statement

No potential conflict of interest relevant to this article is reported.

Figures

Figure 1
Figure 1
(A) 12-lead electrocardiogram obtained during the chest pain showed ST segment elevation with tall T waves in leads I, aVL, and V4-6 and reciprocal ST segment depression in leads V1-2. (B) During a recurrence of the chest pain, ST segment elevation was seen in leads II, III, aVF, and V4-6 and reciprocal ST segment depression in leads V1-3.
Figure 2
Figure 2
The left coronary angiogram in a right anterior oblique caudal projection showed a significant ostial lesion (arrow) in the left circumflex coronary artery.
Figure 3
Figure 3
The left coronary angiogram in a left anterior oblique caudal projection after percutaneous coronary intervention with drug-eluting stent implantation (3.5 × 1.6 mm; TAXUS).
Figure 4
Figure 4
Repeated left coronary angiogram in a right anterior oblique caudal projection showed a widely patent stent.
See this image and copyright information in PMC

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