Gondal Muhammad Umer Riaz, Lemoine John, Segal Jared, Kiyani Zainab, Bilal Muhammad Ibraiz, Ansari Fawwad, McCauley Brian
Department of Internal Medicine, Reading Hospital, West Reading, USA.
Department of Internal Medicine, Drexel University, West Reading, USA.
Eur J Case Rep Intern Med. 2024 Mar 21;11(4):004417. doi: 10.12890/2024_004417. eCollection 2024.
Combination-based adjuvant chemotherapy utilising capecitabine and oxaliplatin is widely used in gastric cancer treatment. Rare but severe cardiac events such as prolonged QT, cardiac arrest and cardiogenic shock can result from their use.
A 45-year-old female with gastric adenocarcinoma was started on capecitabine-oxaliplatin chemotherapy one week before presenting to the emergency department with weakness. Blood pressure was 78/56 mmHg, heart rate 140 bpm and oxygen saturation 85%. She became unresponsive with pulseless ventricular fibrillation; CPR was initiated with immediate intubation. She received two shocks with a return of spontaneous circulation. Laboratory tests revealed serum potassium (3.1 mmol/l), magnesium (1.1 mg/dl) and troponin (0.46 ng/ml). An EKG revealed sinus tachycardia with a prolonged QT interval (556 ms). The combined effects of capecitabine, oxaliplatin and electrolyte abnormalities likely contributed to the QT prolongation. An echocardiogram demonstrated an ejection fraction of 10%-15%. An emergent right-heart catheterisation showed right atrial pressure of 10 mmHg and pulmonary artery pressure of 30/18 mmHg; cardiac output and index were not recorded. An intra-aortic balloon pump was placed, and she was admitted to the ICU for cardiogenic shock requiring norepinephrine, vasopressin and dobutamine. A repeat echocardiogram showed a significantly improved ejection fraction of 65%, and she was discharged.
Capecitabine and oxaliplatin cardiotoxicity is an exceedingly rare occurrence, with both drugs reported to cause QT prolongation.
Healthcare providers must recognise the QT prolongation effects of capecitabine and oxaliplatin, leading to life-threatening cardiac arrhythmias.
Recognise the QT-prolonging effects of capecitabine and oxaliplatin-based chemotherapy.Recognise that cardiogenic shock and cardiac arrest with capecitabine and oxaliplatin-based chemotherapy can occur in individuals with benign cardiac history, especially early in treatment.
基于卡培他滨和奥沙利铂的联合辅助化疗广泛应用于胃癌治疗。使用这些药物可能导致罕见但严重的心脏事件，如QT间期延长、心脏骤停和心源性休克。
一名45岁女性胃腺癌患者在开始卡培他滨-奥沙利铂化疗一周后因身体虚弱就诊于急诊科。血压为78/56 mmHg，心率140次/分钟，血氧饱和度85%。她出现无反应性室颤；立即开始心肺复苏并插管。她接受了两次电击后恢复自主循环。实验室检查显示血清钾（3.1 mmol/L）、镁（1.1 mg/dl）和肌钙蛋白（0.46 ng/ml）。心电图显示窦性心动过速，QT间期延长（556毫秒）。卡培他滨、奥沙利铂和电解质异常的综合作用可能导致了QT间期延长。超声心动图显示射血分数为10%-15%。紧急右心导管检查显示右心房压力为10 mmHg，肺动脉压力为30/18 mmHg；未记录心输出量和心指数。置入主动脉内球囊泵，她因心源性休克入住重症监护病房，需要使用去甲肾上腺素、血管加压素和多巴酚丁胺。复查超声心动图显示射血分数显著提高至65%，随后出院。
卡培他滨和奥沙利铂的心脏毒性极为罕见，两种药物均有导致QT间期延长的报道。
医疗保健人员必须认识到卡培他滨和奥沙利铂的QT间期延长作用，这可能导致危及生命的心律失常。
认识基于卡培他滨和奥沙利铂化疗的QT间期延长作用。认识到基于卡培他滨和奥沙利铂化疗导致的心源性休克和心脏骤停可发生在心脏病史良好的个体中，尤其是在治疗早期。
