title: Prinzmetal angina (Coronary vasospasm) associated with 5-fluorouracil chemotherapy.
abstract: Several chemotherapeutic agents are known to be cardiotoxic. One of them, 5-fluorouracil (5-FU), has been associated with coronary ischemia and reversible vasospasm. In this report, we describe a 54-year-old man with rectal cancer who developed chest pain during 5-FU infusion. His initial electrocardiogram (ECG), obtained while he was experiencing chest pain, showed hyperacute T waves in the anterolateral leads. Those waves disappeared along with the chest pain after administration of sublingual nitroglycerine. An urgent coronary angiogram revealed that the patient had no significant flow-limiting coronary artery disease to account for this chest pain. The final diagnosis was coronary artery spasm with moderate global left ventricular dilatation suggestive of nonischemic cardiomyopathy. During 3days of hospitalization, the patient remained pain free and therefore was discharged. To our knowledge, this is the first case report in the emergency medicine literature demonstrating a coronary vasospastic event associated with 5-FU cardiac toxicity.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, University of Toronto, Canada.
authors.forename: Maxim
authors.initials: M
authors.lastname: Ben-Yakov
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, United States. Electronic address: amalmattu@comcast.net.
authors.forename: Amal
authors.initials: A
authors.lastname: Mattu
authors.affiliation: Department of Emergency Medicine, University of Virginia School of Medicine, United States.
authors.forename: William J
authors.initials: WJ
authors.lastname: Brady
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, United States.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Dubbs
mesh_terms: D000286:Administration, Sublingual; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D002637:Chest Pain / Q000139:chemically induced; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000175:diagnosis; D004562:Electrocardiography; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use*; D012004:Rectal Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin; D005472:Fluorouracil
keywords: Angina pectoris; Coronary vasospasm; Fluorouracil; Prinzmetal angina