Acute Myocardial Infarction in Patient With Triple Negative Breast Cancer After Paclitaxel Infusion: A Case Report

Abstract

A 47-year-old woman with breast cancer suffered progressive chest pain and flushing within 5 minutes of her second exposure to paclitaxel. Her symptoms progressed and she became pulseless. Advanced cardiac life support (ACLS) was initiated, and after a series of chest compressions the cardiac monitor revealed ventricular fibrillation. With ongoing ACLS she was transferred to the emergency department where she regained a pulse. Review of electrocardiogram revealed prominent ST elevation in leads V1, V2 and V3 with reciprocal ST depression. She was transferred urgently to the catheterization laboratory. Angiography revealed a high-grade stenosis in the proximal left anterior descending artery (LAD), and drug-eluting stents were placed without complications. She was then transferred to the floor and shortly thereafter suffered pulseless electrical activity and died despite prolonged attempts at resuscitation. Herein, we describe the development of acute myocardial infarction after paclitaxel administration, discuss potential etiologies and review evidence for an allergic component.

Keywords: Allergic myocardial infarction; Kounis syndrome; Paclitaxel.

Figure 1

ECG revealing diffuse ST elevations at V1-V3 with reciprocal changes of leads II, III and aVF.

Figure 2

(A) Coronary angiography revealing 95% stenosis of proximal LAD (solid arrow) and diffuse vasospasm distally (broken arrows). (B) Post percutaneous coronary intervention and coronary nitroglycerin (solid arrow).