5-FLUORACIL AS A CAUSE OF ACUTE CORONARY THROMBOSIS

Abstract

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: 5-Fluorouracil (5-FU) is considered to be the backbone of colorectal cancer (CRC) systemic therapy since the great majority of recommended regimens include its administration. However, there are a few reports showing direct cardiac toxicity of the drug due to direct heart injury or less common coronary thrombosis. We report a patient with known stable CAD and new episode of chest pain after 5-FU injection for CRC treatment. CASE PRESENTATION: This is a 51-year-old man with a past medical history significant for CAD with previous coronary bypass surgery and CRC in chemotherapy with 5-FU who presented at emergency department with chest discomfort. He had his outpatient chemotherapy and minutes after the infusion of the drug patient developed anterior chest pain, sharp, associated with nausea and vomiting. Initial troponins were positive, but ECG did not show any signs of acute ischemia. Because of hypoxia and low blood pressure, patient was intubated and sent to the intensive care unit. Echocardiogram showed reduced ejection fraction with wall motion abnormalities. Patient performed a left heart catheterization which showed an acute occluded saphenous graft to marginal branch of the circumflex artery. A drug-eluting stent was placed and after 7 days of recovery, patient was discharged home. DISCUSSION: Chemotherapy toxicity with 5-FU is a rare phenomenon with sparse cases described in the literature. There are a few explanations for its toxicity including direct vasculature lesion and also diffuse, severe vasospasm of coronary arteries. It is more common in patients with previous coronary artery disease and it seems to be more dangerous when the medication is given in a bolus regimen instead of continuous infusion. CONCLUSIONS: Patients presenting with chest pain in use of 5-FU have a broad differential which includes direct cardiotoxicity caused by the drug and acute coronary syndrome. The correct diagnosis is crucial, and the first step should be discontinuation of the drug with an integrated approach involving critical care team, oncology, and cardiology. Reference #1: Abdel-Rahman O. 5-Fluorouracil-related Cardiotoxicity; Findings From Five Randomized Studies of 5-Fluorouracil-based Regimens in Metastatic Colorectal Cancer. Clin Colorectal Cancer. 2019;18(1):58–63. Reference #2: Sara JD, Kaur J, Khodadadi R, Rehman M, Lobo R, Chakrabarti S, et al. 5-Fluorouracil and Cardiotoxicity: a Review. Ther Adv Med Oncol. 2018;10. Reference #3: Polk A, Vistisen K, Vaage-Nilsen M, Nielsen DL. A systematic review of the pathophysiology of 5-fluorouracil-induced cardiotoxicity. BMC Pharmacol Toxicol. 2014;15(1):1–11. DISCLOSURES: No relevant relationships by Susan Bannon, source=Web Response No relevant relationships by Ricardo De Castro, source=Web Response No relevant relationships by Michelle Helbig, source=Web Response No relevant relationships by Neiberg de Alcantara Lima, source=Web Response No relevant relationships by Aditya Mehta, source=Web Response