Kabat Maciej, Padalkar Roma, Hazaveh Sara, Joseph Vladimir, Feigenblum David, Sadikot Sean
Department of Internal Medicine, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ, 07601, USA.
Department of Cardiology, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ, 07601, USA.
Cardiooncology. 2024 Feb 27;10(1):11. doi: 10.1186/s40959-024-00214-4.
Capecitabine, a pro-drug of 5-fluorouracil, is commonly used in the treatment of breast and colorectal cancer. Its side effects, including nausea, vomiting, diarrhea, fatigue, loss of appetite, and bone marrow suppression, are well recognized. However, coronary vasospasm represents a less commonly recognized but significant complication of fluoropyrimidine-based therapies such as capecitabine. Proposed mechanisms for this adverse effect complication include direct endothelium-independent vasoconstriction, activation of protein kinase C, and activation of the cyclooxygenase pathway. In this report, we present a case of capecitabine-induced coronary vasospasm leading to progressive, focal ST-elevations, myocardial ischemia, and subsequently polymorphic ventricular tachycardia. These events were captured on telemetry, in a male in his early 40s, diagnosed with stage IIIB sigmoid colon cancer. Notably, the patient had no pre-existing coronary artery disease or other cardiovascular risk factors. Upon diagnosis, the patient was initiated on a calcium channel blocker, verapamil, to mitigate further coronary vasospasm events. After thorough discussions that prioritized the patient's input and values, an implantable cardioverter-defibrillator was placed subcutaneously. Following discharge, the patient restarted capecitabine therapy along with verapamil prophylaxis and did not experience any subsequent shocks from his ICD as assessed during his outpatient follow-up visits. This case emphasizes the need to involve patients in decision-making processes, especially when managing unexpected and serious complications, to ensure treatments align with their quality of life and personal preferences.
卡培他滨是5-氟尿嘧啶的前体药物，常用于治疗乳腺癌和结直肠癌。其副作用包括恶心、呕吐、腹泻、疲劳、食欲不振和骨髓抑制，这些都是广为人知的。然而，冠状动脉痉挛是一种较少被认识但很重要的基于氟嘧啶类疗法（如卡培他滨）的并发症。这种不良反应并发症的推测机制包括直接的非内皮依赖性血管收缩、蛋白激酶C的激活以及环氧化酶途径的激活。在本报告中，我们呈现了一例卡培他滨诱导的冠状动脉痉挛病例，该痉挛导致了进行性、局灶性ST段抬高、心肌缺血，随后出现多形性室性心动过速。这些事件通过遥测记录下来，患者是一名40岁出头的男性，被诊断为IIIB期乙状结肠癌。值得注意的是，该患者既往没有冠状动脉疾病或其他心血管危险因素。诊断后，患者开始使用钙通道阻滞剂维拉帕米，以减轻进一步的冠状动脉痉挛事件。在充分讨论并优先考虑患者的意见和价值观后，皮下植入了植入式心律转复除颤器。出院后，患者重新开始卡培他滨治疗并同时使用维拉帕米预防，在门诊随访期间评估发现，他的植入式心律转复除颤器没有再发出任何电击。该病例强调了让患者参与决策过程的必要性，特别是在处理意外和严重并发症时，以确保治疗符合他们的生活质量和个人偏好。
