Severe heart failure secondary to 5-fluorouracil and low-doses of folinic acid: usefulness of an intra-aortic balloon pump.
OBJECTIVE
To report 5-fluorouracil in combination with folinic acid as a cause of severe nonischemic heart failure and to demonstrate the potential usefulness of an intra-aortic balloon pump.


METHODS
Case report.


METHODS
An adult, 19-bed medical/surgical intensive care unit of a university hospital.


METHODS
A patient, who developed severe heart failure secondary to 5-fluorouracil infusion with low-dose folinic acid, which was introduced to treat a rectal cancer, was transferred from a cancer institute to our intensive care unit 4 days after the treatment was initiated.


METHODS
Electrocardiography, determination of level of cardiac enzymes, echocardiography, radial arterial catheterization, mechanical ventilatory support, continuous venovenous hemodialysis, vasopressors, and secondary intra-aortic balloon pump.


RESULTS
During shock, the patient's systolic blood pressure progressively decreased to 70 mm Hg, despite inotropic agents and vasopressors. Transesophageal echocardiography showed a calculated left ventricular ejection fraction within 20% with global hypokinesia. Electrocardiography showed sinus tachycardia with only nonspecific ST-T changes. Results of serial determination of levels of cardiac enzymes were not significant for myocardial infarction. Treatment with an intraaortic balloon pump was initiated and resulted in a dramatical improvement within 48 hrs. The patient was gradually weaned from vasopressors and the intra-aortic balloon pump. By the tenth day, echocardiography showed a septoapical hypokinesia with a 50% left ventricular ejection fraction. On the 30th day, the echocardiography was considered normal.


CONCLUSIONS
Intravenous 5-fluorouracil in combination with low doses of folinic acid can induce severe nonischemic heart failure. In such a case, an intra-aortic balloon pump could be useful by providing left ventricular function support when inotropic agents and vasopressors fail to restore normal hemodynamics.
David
J S
JS
Department of Anesthesiology and Intensive Care, Edouard Herriot Hospital, University of Lyon, France. js-david@univ-lyon1.fr
Gueugniaud
P Y
PY
Hepp
A
A
Gaussorgues
P
P
Petit
P
P
D000230:Adenocarcinoma / Q000188:drug therapy; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D017548:Echocardiography, Transesophageal; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects*; D006333:Heart Failure / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D002955:Leucovorin / Q000008:administration & dosage*; D012004:Rectal Neoplasms / Q000188:drug therapy; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000187:drug effects
D000964:Antimetabolites, Antineoplastic; D014662:Vasoconstrictor Agents; D002955:Leucovorin; D005472:Fluorouracil