Gemcitabine-induced acute coronary syndrome: a case report.
OBJECTIVE
To report a case of metastatic leiomyosarcoma, in which a patient developed chest pain accompanied by acute left bundle-branch block (LBBB) after gemcitabine infusion.


METHODS
A 59-year-old woman admitted with bilateral pulmonary nodules had classic risk factors for coronary heart disease and coronary stenosis as demonstrated by previous coronary angiography. She was treated with gemcitabine infusion, and 30 min later she experienced severe chest pain accompanied by acute LBBB confirmed by ECG. We suspected gemcitabine-induced coronary vasospasm exacerbated by the preexisting coronary artery disease as the cause of the acute coronary syndrome. The patient was subsequently treated with antianginal therapy and percutaneous coronary intervention. Her chest pain resolved and LBBB disappeared. She was discharged 2 days later without any further cardiac events. No additional cancer therapy was given and she died 5 months later, due to disease progression.


CONCLUSIONS
This case showed that chemotherapeutic agents must be administered with intensive cardiac monitoring especially in patients with cardiac disease and well-known risk factors to prevent the development of cardiac complications, despite an agent not being known to be 'cardiotoxic'.
Ozturk
Banu
B
Department of Medical Oncology, Gazi University Medical School, Ankara, Turkey.
Tacoy
Gulten
G
Coskun
Ugur
U
Yaman
Emel
E
Sahin
Giray
G
Buyukberber
Suleyman
S
Yildiz
Ramazan
R
Kaya
Ali O
AO
Topal
Salih
S
Ozdemir
Murat
M
Benekli
Mustafa
M
D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use; D002037:Bundle-Branch Block / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000150:complications*; D003329:Coronary Vasospasm / Q000139:chemically induced; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D004562:Electrocardiography; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma; D008175:Lung Neoplasms / Q000556:secondary; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000093542:Gemcitabine
D000964:Antimetabolites, Antineoplastic; D010975:Platelet Aggregation Inhibitors; D003841:Deoxycytidine; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D000093542:Gemcitabine