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Acute Myocardial Infarction Following 5-Fluorouracil Use

Year 2019, Volume: 1 Issue: 2, 73 - 76, 17.07.2019

Abstract

Fluorouracil (5-FU) is the most common chemotherapeutic agent suggested for colorectal cancers. Cardiogenic side effects such as coroner artery vasospasm, ventricular dysrhythmia, and cardiac ischemia are also rarely stated. 48-year-old male patient applied to the emergency service with conditions of chest pain, nausea and vomiting. ECG was performed and found to be normal sinus rhythm. In the control ECG of the patient, there were ST elevations in inferior and anterior derivations. The control troponin value for the patient was found to be 0,073 μg/L (normal range 0,010-0.023 μg/L). When the patient expressed that his chest pain aggravated even more as he was being prepared for coroner angiography, control ECG was reperformed and seen that lateral derivations were added to ST elevations in inferior and anterior derivations. The patient, who has started to chemotherapy two days ago and still receives 5-FU infusion, is thought to have myocardial infarction with ST elevation based on the cardiotoxic impact of 5-FU, and he was taken to coroner angiography. His CAG is reported as LAD: Plaque CX: Plaque RCA: 40% lesion observed at CB alignment. 5-FU is a partner medical agent used to treat head and neck, gastrointestinal system, bladder, and chest malignancies. Despite cardiac toxicity being a rare and serious complication, the life-threatening toxicity is observed in 0,5% of the patients. In the previous reports, it is underlined that the only mechanism contributing to STEMI development after 5-FU infusion is vasospasm. In our case, the patient came to us with myocardial infarction with ST elevation resulting from the emergence of chest pain after the use of 5-FU. Patients should be closely followed when receiving 5-FU treatment. Due to the cardiac side effects that may seriously show a fatal course, patients should be examined in detail before the treatment.

References

  • 1.de Gramont Ad, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 2000;18(16):2938–47.
  • 2. Shimura T, Fuse N, Yoshino T, et al. Clinical features of interstitial lung disease induced by standard chemotherapy (FOLFOX or FOLFIRI) for colorectal cancer. Ann Oncol 2010;21:2005–10.
  • 3. Alter P, Herzum M, Soufi M, Schaefer JR, Maisch B. Cardiotoxicity of 5-fluorouracil. Cardiovasc Hematol Agents Med Chem 2006;4: 1–5.
  • 4. Fidan E, Fidan S, Yildiz B, et al. Bolus fluorouracil induced syncope and pulseless ventricular tachycardia: a case report. Hippokratia 2011;15:93–5.
  • 5. Luwaert RJ, Descamps O, Majois F, Chaudron JM, Beauduin M. Coronary-artery spasm induced by 5-fluorouracil. Eur Heart J 1991;12:468–70.
  • 6. Sorrentino MF, Kim J, Foderaro AE, Truesdell AG. 5-Fluorouracil induced cardiotoxicity: review of the literature. Cardiol J 2012;19: 453–8.
  • 7. Sorrentino MF, Kim J, Foderaro AE, Truesdell AG, 5-fluorouracil induced cardiotoxicity: review of the li¬terature. Cardiol J 2012;19:453-458. http://dx.doi.org/10.5603/CJ.2012.0084
  • 8. Alter P, Herzum M, Soufi M, Schaefer JR, Maisch B, Cardiotoxicity of 5-fluouracil. Cardiovasc Hematol Agents Med Chem 2006;4:1-5.
  • 9. Wacker A, Lersch C, Scherpinski U et al. (2003) 5-fluorourasil ile tedavi edilen hastalarda yüksek angina pektoris insidansı: 102 hasta ile planlanan bir sürveyans araştırması. Onkoloji 65: 108-112CrossRef PubMed Google Akademik
  • 10. Forni M de, Malet-Martino MC, Jaillais P ve ark. (1992) Yüksek dozlu sürekli fluorourasil infüzyonunun kardiyotoksisitesi: prospektif klinik bir çalışma. J Clin Oncol 10: 1795-1801Google Akademik
  • 11. Kleiman NS, Lehane DE, Geyer CE, et al. Prinzmetal’s angına during 5-fluorouracil chemotherapy. Am J Med.1987;82:566-8.
Year 2019, Volume: 1 Issue: 2, 73 - 76, 17.07.2019

Abstract

Florourasil (5-FU), kolorektal kanserler için önerilen en yaygın kemoterapötik ajandır. Bu ajana bağlı, koroner arter vazospazmı, ventriküler disritmi ve kardiyak iskemi gibi kardiyojenik yan etkiler nadir olsa da bildirilmiştir. 48 yaşında erkek hasta acil servise göğüs ağrısı, bulantı ve kusma şikayeti ile başvurdu. Çekilen ilk EKG’si normal sinus ritmi olarak değerlendirildi. Kontrol EKG’sinde, inferior ve anterior’da ST segment yükselmeleri mevcuttu. Hasta için çalışılan kontrol troponin değeri 0,073 μg/L (normal aralık 0,010-0,023 μg/L) olarak geldi. Hasta, koroner anjiyografi için hazırlanırken göğüs ağrısının daha da şiddetlendiğini ifade etti. Bunun üzerine tekrarlanan EKG’de, anterior ve inferior derivasyonlara, lateral derivasyonda, ST segment yükselmesinin eklendiğini görüldü. İki gün önce kemoterapiye başlayan ve hala 5-FU infüzyonu alan hastanın, 5-FU’nun kardiyotoksik etkisine bağlı ST yükselmeli miyokard enfarktüsü geçirdiği düşünüldü. koroner anjiyografiye alınan hastada. Anjiografi sonucu LAD: Plak CX: Plak RCA: CB hizasında gözlenen% 40 lezyon olduğu bildirildi. 5-FU,baş, boyun, gastrointestinal sistem, mesane ve göğüs malignitelerini tedavi etmek için kullanılan ortak bir tıbbi ajandır. Kardiyak toksisite nadir ve ciddi bir komplikasyondur ve yaşamı tehdit eden toksisite hastaların% 0,5’inde görülür. Önceki çalışmalarda, 5-FU infüzyonundan sonra STEMI gelişimine katkıda bulunan tek mekanizmanın vazospazm olduğu vurgulanmıştır. 5-FU tedavisi alırken hastalar yakından takip edilmelidir. Ciddi ölümcül seyir gösterebilecek kalp yan etkileri nedeniyle, hastalar tedaviden önce ayrıntılı olarak incelenmelidir. 

References

  • 1.de Gramont Ad, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 2000;18(16):2938–47.
  • 2. Shimura T, Fuse N, Yoshino T, et al. Clinical features of interstitial lung disease induced by standard chemotherapy (FOLFOX or FOLFIRI) for colorectal cancer. Ann Oncol 2010;21:2005–10.
  • 3. Alter P, Herzum M, Soufi M, Schaefer JR, Maisch B. Cardiotoxicity of 5-fluorouracil. Cardiovasc Hematol Agents Med Chem 2006;4: 1–5.
  • 4. Fidan E, Fidan S, Yildiz B, et al. Bolus fluorouracil induced syncope and pulseless ventricular tachycardia: a case report. Hippokratia 2011;15:93–5.
  • 5. Luwaert RJ, Descamps O, Majois F, Chaudron JM, Beauduin M. Coronary-artery spasm induced by 5-fluorouracil. Eur Heart J 1991;12:468–70.
  • 6. Sorrentino MF, Kim J, Foderaro AE, Truesdell AG. 5-Fluorouracil induced cardiotoxicity: review of the literature. Cardiol J 2012;19: 453–8.
  • 7. Sorrentino MF, Kim J, Foderaro AE, Truesdell AG, 5-fluorouracil induced cardiotoxicity: review of the li¬terature. Cardiol J 2012;19:453-458. http://dx.doi.org/10.5603/CJ.2012.0084
  • 8. Alter P, Herzum M, Soufi M, Schaefer JR, Maisch B, Cardiotoxicity of 5-fluouracil. Cardiovasc Hematol Agents Med Chem 2006;4:1-5.
  • 9. Wacker A, Lersch C, Scherpinski U et al. (2003) 5-fluorourasil ile tedavi edilen hastalarda yüksek angina pektoris insidansı: 102 hasta ile planlanan bir sürveyans araştırması. Onkoloji 65: 108-112CrossRef PubMed Google Akademik
  • 10. Forni M de, Malet-Martino MC, Jaillais P ve ark. (1992) Yüksek dozlu sürekli fluorourasil infüzyonunun kardiyotoksisitesi: prospektif klinik bir çalışma. J Clin Oncol 10: 1795-1801Google Akademik
  • 11. Kleiman NS, Lehane DE, Geyer CE, et al. Prinzmetal’s angına during 5-fluorouracil chemotherapy. Am J Med.1987;82:566-8.
There are 11 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Case Reports
Authors

Şükrü Gürbüz

Muhammed Ekmekyapar

Hakan Oğuztürk This is me

Neslihan Yücel This is me

M. Gökhan Turtay

Serdar Derya This is me

Publication Date July 17, 2019
Submission Date January 11, 2019
Published in Issue Year 2019 Volume: 1 Issue: 2

Cite

APA Gürbüz, Ş., Ekmekyapar, M., Oğuztürk, H., Yücel, N., et al. (2019). Acute Myocardial Infarction Following 5-Fluorouracil Use. Eurasian Journal of Toxicology, 1(2), 73-76.
AMA Gürbüz Ş, Ekmekyapar M, Oğuztürk H, Yücel N, Turtay MG, Derya S. Acute Myocardial Infarction Following 5-Fluorouracil Use. Eurasian J Tox. July 2019;1(2):73-76.
Chicago Gürbüz, Şükrü, Muhammed Ekmekyapar, Hakan Oğuztürk, Neslihan Yücel, M. Gökhan Turtay, and Serdar Derya. “Acute Myocardial Infarction Following 5-Fluorouracil Use”. Eurasian Journal of Toxicology 1, no. 2 (July 2019): 73-76.
EndNote Gürbüz Ş, Ekmekyapar M, Oğuztürk H, Yücel N, Turtay MG, Derya S (July 1, 2019) Acute Myocardial Infarction Following 5-Fluorouracil Use. Eurasian Journal of Toxicology 1 2 73–76.
IEEE Ş. Gürbüz, M. Ekmekyapar, H. Oğuztürk, N. Yücel, M. G. Turtay, and S. Derya, “Acute Myocardial Infarction Following 5-Fluorouracil Use”, Eurasian J Tox, vol. 1, no. 2, pp. 73–76, 2019.
ISNAD Gürbüz, Şükrü et al. “Acute Myocardial Infarction Following 5-Fluorouracil Use”. Eurasian Journal of Toxicology 1/2 (July 2019), 73-76.
JAMA Gürbüz Ş, Ekmekyapar M, Oğuztürk H, Yücel N, Turtay MG, Derya S. Acute Myocardial Infarction Following 5-Fluorouracil Use. Eurasian J Tox. 2019;1:73–76.
MLA Gürbüz, Şükrü et al. “Acute Myocardial Infarction Following 5-Fluorouracil Use”. Eurasian Journal of Toxicology, vol. 1, no. 2, 2019, pp. 73-76.
Vancouver Gürbüz Ş, Ekmekyapar M, Oğuztürk H, Yücel N, Turtay MG, Derya S. Acute Myocardial Infarction Following 5-Fluorouracil Use. Eurasian J Tox. 2019;1(2):73-6.

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