Y-Hassan Shams, Tornvall Per, Törnerud Mattias, Henareh Loghman
Department of Cardiology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden.
Cardiovasc Revasc Med. 2013 Jan-Feb;14(1):57-61. doi: 10.1016/j.carrev.2012.10.001. Epub 2012 Dec 5.
5-Fluorouracil (5-FU) and its oral pro-drug capecitabine are widely used in oncology for the treatment of various solid tumours, including colorectal cancers. Cardiotoxicity to these drugs is not an uncommon adverse effect and has been reported in 1%-18% of patients. Capecitabine has been reported to trigger mid-apical Takotsubo syndrome (TS). We describe here the case of a 55-year-old man who presented with cardiogenic shock and ECG signs of ST-elevation myocardial infarction. The symptoms began 28 h after the commencement of capecitabine adjuvant therapy, following a radical right-sided hemicolectomy for low-differentiated adenocarcinoma of the caecum. Echocardiography showed severe global left ventricular dysfunction. Cardiac magnetic resonance imaging showed no signs of late gadolinium enhancement. These clinical, cardiac image study findings and the course of the disease with full recovery within one week were consistent with global TS triggered by the adjuvant therapy capecitabine and presenting with a life-threatening cardiogenic shock. Moreover, we have demonstrated the speedy dynamic of the left ventricular wall motion abnormality with global TS at presentation and basal (inverted) TS findings 4 days later on.
5-氟尿嘧啶（5-FU）及其口服前体药物卡培他滨在肿瘤学中被广泛用于治疗各种实体瘤，包括结直肠癌。这些药物的心脏毒性并非罕见的不良反应，据报道在1%-18%的患者中出现过。据报道，卡培他滨会引发心尖中部Takotsubo综合征（TS）。我们在此描述一名55岁男性的病例，他出现了心源性休克以及ST段抬高型心肌梗死的心电图表现。症状在卡培他滨辅助治疗开始28小时后出现，此前患者因盲肠低分化腺癌接受了根治性右半结肠切除术。超声心动图显示左心室严重整体功能障碍。心脏磁共振成像未显示晚期钆增强迹象。这些临床、心脏影像学研究结果以及疾病在一周内完全康复的病程与卡培他滨辅助治疗引发的整体TS一致，并伴有危及生命的心源性休克。此外，我们还展示了发病时左心室壁运动异常的快速动态变化以及4天后出现的基底（倒置）TS表现。
