title: Capecitabine caused cardiogenic shock through induction of global Takotsubo syndrome.
abstract: 5-Fluorouracil (5-FU) and its oral pro-drug capecitabine are widely used in oncology for the treatment of various solid tumours, including colorectal cancers. Cardiotoxicity to these drugs is not an uncommon adverse effect and has been reported in 1%-18% of patients. Capecitabine has been reported to trigger mid-apical Takotsubo syndrome (TS). We describe here the case of a 55-year-old man who presented with cardiogenic shock and ECG signs of ST-elevation myocardial infarction. The symptoms began 28 h after the commencement of capecitabine adjuvant therapy, following a radical right-sided hemicolectomy for low-differentiated adenocarcinoma of the caecum. Echocardiography showed severe global left ventricular dysfunction. Cardiac magnetic resonance imaging showed no signs of late gadolinium enhancement. These clinical, cardiac image study findings and the course of the disease with full recovery within one week were consistent with global TS triggered by the adjuvant therapy capecitabine and presenting with a life-threatening cardiogenic shock. Moreover, we have demonstrated the speedy dynamic of the left ventricular wall motion abnormality with global TS at presentation and basal (inverted) TS findings 4 days later on.
authors.affiliation: Department of Cardiology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden. shams.younis-hassan@karolinska.se
authors.forename: Shams
authors.initials: S
authors.lastname: Y-Hassan
authors.forename: Per
authors.initials: P
authors.lastname: Tornvall
authors.forename: Mattias
authors.initials: M
authors.lastname: Törnerud
authors.forename: Loghman
authors.initials: L
authors.lastname: Henareh
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000601:surgery; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D000069287:Capecitabine; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002430:Cecal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003082:Colectomy; D017023:Coronary Angiography; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D004452:Echocardiography; D004562:Electrocardiography; D005472:Fluorouracil / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012770:Shock, Cardiogenic / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D054549:Takotsubo Cardiomyopathy / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000964:Antimetabolites, Antineoplastic; D002317:Cardiovascular Agents; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil