title: A case of variant angina in a patient under chronic treatment with sorafenib.
abstract: BACKGROUND
  A 63-year-old man with an unresectable multifocal hepatocellular carcinoma (HCC) presented with upper abdominal discomfort, nausea and vomiting. We report a case of variant angina in a patient affected by unresectable HCC under chronic treatment with sorafenib. Spontaneous spasm occurred during cardiac catheterization and was revealed during coronary angiogram with the unusual feature of a retrograde transient filling of a contralateral branch.
  
  
  METHODS
  Electrocardiogram, cardiac catheterization, chest X-ray, emergency ECG.
  
  
  METHODS
  Variant angina induced by sorafenib treatment mimicking infero-posterior ST-elevation myocardial infarction (STEMI).
  
  
  RESULTS
  High-dose calcium-antagonists and nitrates were initially given intravenously and then orally. Sorafenib therapy was then resumed without further symptoms. Restaging of the cancer revealed unexpected local recurrence and the patient died 1 month after receiving palliative care. We contend that the effects of sorafenib treatment were primarily responsible for the major cardiovascular event observed in this case, and it is important for clinicians to be aware of this possible severe complication of sorafenib therapy.
authors.affiliation: Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy. italo.porto@gmail.com
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Andrea
authors.initials: A
authors.lastname: Leo
authors.forename: Luca
authors.initials: L
authors.lastname: Miele
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pompili
authors.forename: Raffaele
authors.initials: R
authors.lastname: Landolfi
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000788:Angina Pectoris, Variant / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001557:Benzenesulfonates / Q000009:adverse effects* / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D006328:Cardiac Catheterization; D002908:Chronic Disease; D017023:Coronary Angiography; D004562:Electrocardiography; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use; D000077157:Sorafenib; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib