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一名结直肠癌患者发生化疗诱导的冠状动脉痉挛病例。

A case of chemotherapy-induced coronary vasospasm in a patient with colorectal cancer.

作者信息

Kabir Ryan, Vasquez Nestor, Keshvani Neil, Vongpatanasin Wanpen

机构信息

Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.

出版信息

J Cardiol Cases. 2020 Jun 10;22(3):117-120. doi: 10.1016/j.jccase.2020.05.014. eCollection 2020 Sep.

Abstract

Colorectal cancer kills nearly 700,000 people each year worldwide. The use of chemotherapeutic agents in the treatment of colorectal cancer has broadened considerably over the past few decades. The cardiovascular care of patients being treated with these agents has received increasing attention over recent years due to the known cardiovascular toxicities associated with certain treatment regimens, but there may still be unidentified cardiovascular toxicities. Here we present a case of a patient with colorectal cancer without any modifiable cardiovascular risk factors who experienced coronary vasospasm shortly after initiation of therapy with 5-flourouracil, leucovorin, and oxaliplatin with bevacizumab, despite having previously tolerated boluses of 5-flourouracil alone without incident. Coronary vasospasm attributed to this combination of chemotherapy has never before been reported. Additionally, our case and other available literature demonstrate the efficacy of dihydropyridine calcium channel blocker therapy in treatment of vasospasm induced by chemotherapeutic agents. < Many chemotherapeutic agents have known cardiotoxicities, but there may still be unidentified cardiovascular toxicities. Here we report a case of coronary vasospasm attributed to the combination of a 5-flourouracil containing regimen (FOLFOX) and bevacizumab. Vasospasm attributed to this combination of chemotherapy has never been reported, and our patient was successfully treated with dihydropyridine calcium channel blocker therapy.>.

摘要

全球范围内,结直肠癌每年导致近70万人死亡。在过去几十年中,化疗药物在结直肠癌治疗中的应用范围大幅拓宽。近年来,由于某些治疗方案已知的心血管毒性,接受这些药物治疗的患者的心血管护理受到了越来越多的关注,但可能仍存在未被识别的心血管毒性。在此,我们报告一例结直肠癌患者,该患者没有任何可改变的心血管危险因素,在开始使用5-氟尿嘧啶、亚叶酸钙、奥沙利铂联合贝伐单抗治疗后不久发生了冠状动脉痉挛,尽管该患者此前单独接受大剂量5-氟尿嘧啶治疗时未出现任何不良反应。此前从未有过关于这种化疗联合方案导致冠状动脉痉挛的报道。此外,我们的病例及其他现有文献证明了二氢吡啶类钙通道阻滞剂疗法在治疗化疗药物引起的血管痉挛方面的有效性。<许多化疗药物具有已知的心脏毒性,但可能仍存在未被识别的心血管毒性。在此,我们报告一例由含5-氟尿嘧啶方案(FOLFOX)和贝伐单抗联合导致冠状动脉痉挛的病例。此前从未有过关于这种化疗联合方案导致血管痉挛的报道,我们的患者通过二氢吡啶类钙通道阻滞剂疗法成功治愈。>

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Provocative testing for coronary reactivity and spasm.冠状动脉反应性和痉挛的激发试验。
J Am Coll Cardiol. 2014 Jan 21;63(2):103-9. doi: 10.1016/j.jacc.2013.10.038. Epub 2013 Nov 6.

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