title: Acute presentation of vasospastic angina induced by oral capecitabine: a case report.
abstract: BACKGROUND
  Oral capecitabine is an oral prodrug of 5-fluorouracil that has been integrated into the management of multiple cancer types because of the convenience of administration and its efficacy compared with 5-fluorouracil. Capecitabine mimics the pharmacokinetics of intravenous 5-fluorouracil. While cardiac events associated with the use of 5-fluorouracil are a well-known side effect, capecitabine-induced cardiotoxicity has only been rarely reported.
  
  
  METHODS
  We present a case of a 46-year-old woman of Greek ethnicity who presented to our institution with an operated gastric sarcoma who experienced capecitabine-induced vasospastic angina. Primarily a clinical diagnosis of a possible acute coronary syndrome was proposed and the patient was admitted to the hospital for further investigation which was proved between normal limits. After a witnessed episode of angina, her prior history of capecitabine intake and an undertaken further imaging investigation we associated anginal symptoms and signs with vasospastic angina induced by capecitabine 36 hours prior to hospital admission.
  
  
  CONCLUSIONS
  Cardiologists should be aware of the potential cardiac hazards of capecitabine, especially in patients with cardiovascular risk factors. Due to the increasing usage of capecitabine during the last years, patients should be warned for the possibility of chest pain, particularly during the first few days of capecitabine treatment. Specifically, patients developing acute coronary syndrome should not be retreated with capecitabine. On the other hand, due to its promising antitumoral efficacy, its use should not be discouraged.
authors.forename: Christos
authors.initials: C
authors.lastname: Golias
authors.forename: Georgios
authors.initials: G
authors.lastname: Dimitriadis
authors.forename: Dimokritos
authors.initials: D
authors.lastname: Dimitriadis
authors.forename: Christos
authors.initials: C
authors.lastname: Graidis
authors.forename: Ilias
authors.initials: I
authors.lastname: Dimitrelos
authors.forename: Afroditi
authors.initials: A
authors.lastname: Tsiakou
authors.forename: Theodosis
authors.initials: T
authors.lastname: Bitsis
authors.affiliation: Department of Physiology, Clinical Unit, Medical Faculty, Democritus University of Thrace, Panepistimioupoli, Dragana 68100 Alexandroupolis, Greece. christos_gkolias@yahoo.com.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Charalabopoulos