A Case of 5-Fluorouracil-Induced Cardiac Arrest.
BACKGROUND
Coronary artery vasospasm after administration of fluorouracil (5-FU) is a rare complication. Commonly presenting as chest pain during or shortly after 5-FU infusions, vasospasm can place patients at risk for ventricular dysrhythmia, myocardial ischemia, and infarction. Although not fully understood, any 5-FU cardiotoxicity seems to be multifactorial, and patients with coronary artery disease and renal dysfunction may be at particular risk.


METHODS
A 46-year-old woman with no prior cardiovascular disease history presented with sudden-onset chest pain after initial administration of 5-FU continuous infusion therapy. The patient subsequently developed ventricular fibrillation arrest and underwent successful electrocardioversion. Coronary angiography was unremarkable for coronary stenosis or vasospasm. The presumed etiology was secondary to 5-FU cardiac toxicity. The patient was re-challenged with 5-FU therapy and developed repeat chest pain. The 5-FU was completely stopped and the patient's symptoms resolved, with no further dysrhythmic events 9 months after initial presentation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients who develop chest pain during or after 5-FU infusion should warrant strong consideration for admission and continuous cardiac monitoring for potential ventricular dysrhythmias and cardiac ischemia.
Department of Internal Medicine, Mayo Clinic, Florida, Jacksonville, Florida.
Jordan C
JC
Ray
Department of Internal Medicine, Mayo Clinic, Florida, Jacksonville, Florida.
Paul
P
Cho
Department of Emergency Medicine, Mayo Clinic, Florida, Jacksonville, Florida.
Marc
M
Dragon
Department of Emergency Medicine, Mayo Clinic, Florida, Jacksonville, Florida.
Charles G
CG
Graham
D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D002637:Chest Pain / Q000139:chemically induced*; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects*; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D008875:Middle Aged; D014693:Ventricular Fibrillation / Q000139:chemically induced
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil
FOLFOX; cardiac arrest; cardiotoxicity; chemotherapy; fluorouracil; vasospasm; ventricular tachycardia