title: A case of Takotsubo cardiomyopathy during 5-fluorouracil treatment for rectal adenocarcinoma.
abstract: A case of acute heart failure due to Takotsubo cardiomyopathy induced by 5-fluorouracil is described. Acute heart failure developed during the administration of 5-fluorouracil (5-FU) and levofolinate calcium in a 62-year-old woman who had underwent a Miles operation for rectal adenocarcinoma. Electrocardiography upon admission showed slight ST elevation in leads V1-3, and follow-up electrocardiography on the third hospital day evealed QT interval prolongation and giant negative T waves in leads II, III, aVF, and V1-6. Echocardiography and myocardial scintigraphy showed left ventricular apical ballooning in the acute phase of heart failure, but left ventricular contraction was normal during the recovery phase. Coronary angiography demonstrated normal coronary arteries, and multi-vessel coronary artery vasospasms including microcirculation disorders could be provoked by intracoronary acetylcholine infusion during, but not before, the intravenous administration of levofolinate calcium and 5-FU. The cause of heart failure in this patient, Takotsubo cardiomyopathy induced by multivessel coronary vasospasm including microcirculation disorders only during 5-FU administration, is notable.
authors.affiliation: Department of Internal Medicine, Graduate School of Medicine, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan. s5047@nms.ac.jp
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Noritake
authors.initials: N
authors.lastname: Hata
authors.forename: Shinya
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Takuro
authors.initials: T
authors.lastname: Shinada
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shirakabe
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy*; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects*; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000188:drug therapy*; D054549:Takotsubo Cardiomyopathy / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil