Coronary spasm after injection of ondansetron: Case report and review of the literature

Abstract

1. Background Ondansetron is a selective 5-HT3-receptor antagonist used as an antiemetic agent during chemotherapy, radiother- apy or peri-operative period. It is effective and well tolerated. However, a reappraisal of side effects, especially cardio- vascular, seems useful (1). We report a case of acute myo- cardial ischemia due to the administration of ondansetron. 2. Case report left ventricular global hypokinesis, the only normal wall motion being localized in the posterior area. The left ventricular ejection fraction was estimated at 20%. The apex of the right ventricle was hypokinetic and a pericardial effusion was noticed. A coronarography was normal. The ventriculography confirmed the echographic data, showing an undilated left ventricle, with diffuse severe hypokinesia except for the posterior wall. On the third day, the echocardiogram disclosed a partial recovery of the left ventricular ejection fraction to 35%, with only a wall motion abnormality localized in the anterior area. The ECG and the cardiac enzymes normalized. The echocardiogram per- formed on the seventh day showed only a small septo-apical hypokinesia and a normal left ventricular ejection fraction. On the fifteenth day, the segmentary kinetic was strictly homogeneous and normal. Six months later, the patient was stable and disclosed no sign of cardiac failure or coronary disease. Cyclophosphamide was discontinued and neurological symptoms remained stable.