Spontaneous Coronary Artery Dissection in a Woman Receiving 5-Fluorouracil

Abbott, J. Dawn; Curtis, Jeptha P.; Murad, Khalil; Kramer, Harvey M.; Remetz, Michael S.; Setaro, John F.; Brennan, Joseph

doi:10.1177/000331970305400613

Cited by 14 publications

(17 citation statements)

References 11 publications

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“…Abbot et al (9) reported the case of a 39-year-old woman who presented with an ST segment elevation MI while undergoing 5-FU treatment for cervical cancer. Angiography demonstrated the presence of an extensive coronary artery dissection, which, the authors postulated, was at least partially the result of 5-FUprecipitated vasospasm and hormonal changes related to pelvic radiation (9). Similarly, cisplatin-induced coronary spasm, thrombogenesis and the altered hormonal milieu after the orchiectomy might have precipitated SCAD and the consequent myocardial infarction in our case.…”

Section: Discussionsupporting

confidence: 52%

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An unusual case of chronic coronary artery dissection: Did cisplatin play a role?

Ghosh

Chow

Korley

et al. 2008

Canadian Journal of Cardiology

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S pontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial ischemia (1). It is more common in younger patients and in women, and has a propensity to affect patients without traditional cardiovascular risk factors (2). The tendency to affect women in high estrogenic states suggests that the hormonal and thrombogenic status of the patient may play etiological roles in SCAD. Similar factors have been implicated in increased cardiovascular event rates observed in young patients undergoing chemotherapy for testicular cancer (3). Despite this, no cases of SCAD occurring during cisplatin-based chemotherapy for testicular cancer have been reported.The presentation, outcome and management of acute spontaneous coronary artery dissection have been described extensively (4)(5)(6)(7)(8). In all of these reports, there was either no angiographic follow-up of patients who survived the acute event or follow-up angiography demonstrated complete healing of the dissection. The long-term outcome of the dissection that persists is less well described (9,10).We report a case of chronic coronary artery dissection that had its onset during a course of bleomycin-etoposide-cisplatin therapy for testicular cancer. The implications of testicular cancer and chemotherapy, and the significance of chronic coronary artery dissection persistent on angiography will be discussed. CASE PRESENTATIONA 36-year-old man presented with a history of lightheadedness, shortness of breath and left-sided chest tightness after several minutes of playing hockey. Emergency medical services arrived at the scene and found the patient in monomorphic ventricular tachycardia at approximately 300 beats/min (Figure 1). The patient underwent electrical cardioversion, with almost immediate resolution of his symptoms. On admission to a local hospital, his troponin I peaked at 0.6 μg/L (10 times the upper limit of normal), and his electrocardiogram (ECG) showed significant Q waves in leads II, III and AVF, as well as ST depression in the inferolateral leads. The Q waves in the inferior leads were unchanged from previous ECGs recorded since July 1994. At the time of the current presentation, the patient was taking ramipril and Lipitor (Pfizer, Canada). He did not smoke and rarely used alcohol. He was started on acetylsalicylic acid, clopidogrel, enoxaparin and metoprolol by the referring centre, and was transferred to a tertiary care centre for further investigation.His medical history was relevant. At the age of 24 years he developed testicular cancer, which was treated with four cycles of chemotherapy following orchiectomy. During his last course of bleomycin-etoposide-cisplatin chemotherapy, the patient developed left chest, neck and shoulder discomfort, and presented to the hospital 12 h later. Serial ECGs revealed the development of a Q wave inferior infarction and poor R wave progression across precordial leads on serial tracings. He did not receive thrombolysis, and cardiac catheterization was not performed. He was sent home on acetylsalic...

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Section: Discussionsupporting

confidence: 52%

“…In all of these reports, there was either no angiographic follow-up of patients who survived the acute event or follow-up angiography demonstrated complete healing of the dissection. The long-term outcome of the dissection that persists is less well described (9,10).…”

mentioning

confidence: 99%

An unusual case of chronic coronary artery dissection: Did cisplatin play a role?

Ghosh

Chow

Korley

et al. 2008

Canadian Journal of Cardiology

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“…Another retrospective examination of 377 case reports revealed acute MI in 22% of patients during 5-FU administration [6], while a prospective study of 26 patients suggested infarction by ECG and symptom criteria in nearly 35% of patients receiving 5-FU [1]. Coronary artery dissection causing an ACS has also been described with vasospasm--induced disruption of the endothelium cited as a possible mechanism of action [38].…”

Section: Silent Ischemia and Myocardial Infarctionmentioning

confidence: 99%

5-fluorouracil induced cardiotoxicity: Review of the literature

Sorrentino

Kim²,

Foderaro³

et al. 2012

Cardiol J

180

138

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“…Patients with existing cardiovascular pathology have a high risk of this disease [10]. Some cases of myocardial infarction, sudden death and cardiac arrest associated with the capecitabine intake have been described [11,12].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection during cisplatin and capecitabine therapy

Somov

Марчак

Матусов

et al. 2019

Annals of Medicine and Surgery

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Introduction Spontaneous coronary artery dissection is a rare cardiovascular disease that can cause acute myocardial infarction and sudden cardiac death. The mechanism of this pathology and the optimal treatment are not fully understood. Presentation of case An acute myocardial infarction developed while a fifty five years old woman with a rectal adenocarcinoma was receiving a cisplatin and capecitabine therapy. Coronary angiography demonstrated a multivessel occlusion of coronary arteries. Discussion The authors discuss several factors that may lead to the spontaneous coronary artery dissection including chemotherapy-induced vasospasm. Chemotherapy based on the cisplatin and capecitabine intake can cause a cardiotoxic effect. Conclusion Thus, spontaneous coronary artery dissection is a disease with an extremely complex etiololy, which does not have a special treatment guide. Management should be considered individually for each case.

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Spontaneous Coronary Artery Dissection in a Woman Receiving 5-Fluorouracil

Cited by 14 publications

References 11 publications

An unusual case of chronic coronary artery dissection: Did cisplatin play a role?

An unusual case of chronic coronary artery dissection: Did cisplatin play a role?

5-fluorouracil induced cardiotoxicity: Review of the literature

Spontaneous coronary artery dissection during cisplatin and capecitabine therapy

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