title: 5-Fluorouracil-induced acute reversible heart failure not explained by coronary spasms, myocarditis or takotsubo: lessons from MRI.
abstract: A 69-year-old woman presented with arterial hypotension, pulmonary oedema and a severely depressed left ventricular ejection fraction (LVEF) of 25% only 3 days after having received her first treatment for colorectal cancer with 5-fluorouracil (5-FU)-based therapy. The ECG demonstrated widespread ST-segment depression and echocardiography showed uniform hypokinesia of all left ventricular (LV) myocardial segments without signs of regional LV ballooning. Coronary angiography was normal and the patient gained full recovery after receiving treatment with heart failure medication. Interestingly, cardiac MRI scan 9 days later showed a normal LVEF with signs of neither myocardial oedema nor necrosis. Despite the high therapeutic efficacy of 5-FU in treatment of colorectal cancer, it is associated with undesired cardiac toxicities including coronary spasms, toxic inflammation and takotsubo cardiomyopathy. However, our patient did not fulfil the diagnostic criteria for the aforementioned complications. Based on this case report, we discuss alternative mechanisms including myocardial adenosine triphosphate depletion suggested from animal experiments.
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Department of Medicine, Division of Cardiology, Nykøbing F Hospital, Copenhagen University Hospital, Nykøbing F, Denmark.
authors.forename: Yama
authors.identifier: http://orcid.org/0000-0002-3374-4781
authors.initials: Y
authors.lastname: Fakhri
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Dalsgaard
authors.affiliation: Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Dorte
authors.initials: D
authors.lastname: Nielsen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Lav Madsen
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000188:drug therapy; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects*; D006333:Heart Failure / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D010996:Pleural Effusion / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D016277:Ventricular Function, Left
chemical_list: D005472:Fluorouracil