Yung Lisa Tze Mei, McCrea William Arthur
Great Western Hospital, Marlborough Road, Swindon, SN3 6BB, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.09.2008.0964. Epub 2009 Apr 14.
Capecitabine is an oral chemotherapeutic agent recommended by the National Institute for Clinical Excellence as first line treatment for metastatic bowel cancer and second line for breast cancer. With the increasing prevalence and diagnosis of these common malignancies, it is essential that physicians are made aware of the rare, but potentially fatal, cardiac effects of capecitabine. This case report demonstrates a typical presentation of suspected acute coronary syndrome with associated ECG changes in a patient who had started capecitabine 2 days before admission. His troponin was mildly elevated and his ECGs resolved on discontinuation of the drug, but a positive exercise tolerance test precipitated coronary angiography; which was essentially normal, as was his echocardiogram and computed tomography scan. Previous literature has highlighted potential cardiac complications of a similar chemotherapeutic agent 5-fluorouracil, which is the active metabolite present in capecitabine. The possible presentations, complications and clinical management are discussed in this case report.
卡培他滨是一种口服化疗药物，被英国国家临床优化研究所推荐为转移性肠癌的一线治疗药物和乳腺癌的二线治疗药物。随着这些常见恶性肿瘤的发病率和诊断率不断上升，让医生了解卡培他滨罕见但可能致命的心脏影响至关重要。本病例报告展示了一名患者在入院前2天开始使用卡培他滨后出现疑似急性冠状动脉综合征并伴有相关心电图变化的典型表现。他的肌钙蛋白轻度升高，停药后心电图恢复正常，但阳性运动耐量试验促使进行冠状动脉造影；冠状动脉造影基本正常，他的超声心动图和计算机断层扫描也是如此。先前的文献强调了类似化疗药物5-氟尿嘧啶的潜在心脏并发症，5-氟尿嘧啶是卡培他滨中的活性代谢物。本病例报告讨论了可能的表现、并发症及临床处理。
