Abstract
Takotsubo cardiomyopathy is a rare but increasingly recognized phenomenon, which can occur as a side-effect of chemotherapeutic agents, in particular, the antimetabolite 5-fluorouracil. We describe a case of delayed Takotsubo cardiomyopathy after 3 weeks of adjuvant 5-fluorouracil for resected rectal adenocarcinoma in a 66-year-old female, supported by angiographic, electrocardiographic, and echocardiographic features. As a complication, she developed an apical mural thrombus with subsequent cerebral thromboembolic events and was successfully anticoagulated to make a full recovery. We present a review of the literature on Takotsubo cardiomyopathy secondary to 5-fluorouracil and the rare occurrence of thromboembolic complications. As this is a significant clinical phenomenon which involves a multispeciality approach to management, oncologists and cardiologists need to recognize it as a potential toxicity of a widely administered chemotherapeutic drug.
Highlights
Takotsubo cardiomyopathy (TCM) as a result of exposure to chemotherapeutic agents is a rare but increasing phenomenon
TCM has been noted to occur primarily in association with 5-fluorouracil (5-FU), but it has recently been described with other chemotherapeutic agents such as bevacizumab [1], cetuximab, rituximab, doxorubicin, and cyclophosphamide (R-CHOP) combination [2]
The diagnosis of TCM is primarily based on criteria from the Mayo Clinic [3], defined as transient left ventricular (LV) dysfunction extending beyond a single vascular territory, electrocardiographic changes that can mimic acute myocardial infarction, and minimal release of myocardial enzymes in the absence of obstructive coronary artery disease or acute plaque rupture
Summary
Takotsubo cardiomyopathy (TCM) as a result of exposure to chemotherapeutic agents is a rare but increasing phenomenon. TCM has been noted to occur primarily in association with 5-fluorouracil (5-FU), but it has recently been described with other chemotherapeutic agents such as bevacizumab [1], cetuximab, rituximab, doxorubicin, and cyclophosphamide (R-CHOP) combination [2]. The diagnosis of TCM is primarily based on criteria from the Mayo Clinic [3], defined as transient left ventricular (LV) dysfunction extending beyond a single vascular territory, electrocardiographic changes that can mimic acute myocardial infarction, and minimal release of myocardial enzymes in the absence of obstructive coronary artery disease or acute plaque rupture. All the above criteria must occur in the absence of recent significant head trauma, intracranial bleeding, pheochromocytoma, obstructive epicardial coronary artery disease, myocarditis, or hypertrophic cardiomyopathy. We present a case of delayed TCM whilst receiving adjuvant chemotherapy for rectal adenocarcinoma
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
