Akhtar S S, Salim K P, Bano Z A
Department of Medical Oncology, SK Institute of Medical Sciences, Soura, Srinagar.
Oncology. 1993 Nov-Dec;50(6):441-4. doi: 10.1159/000227226.
Cardiotoxicity with 5-fluorouracil (5-FU) therapy has been reported to range from asymptomatic EKG abnormalities to fatal myocardial infarction. We report a prospective study in 100 consecutive patients receiving 5-FU infusion in combination with other chemotherapeutic agents or alone for the treatment of different malignancies with the aim of identifying patients who develop symptomatic cardiotoxicity. Patients with a history of cardiac illness, abnormal EKG or cardiac enzyme levels were excluded. Patients were observed during the total period of infusion, daily EKG was performed on asymptomatic patients, those who developed cardiotoxicity were monitored till symptom-free for 24 h. Eight patients developed symptoms suggestive of cardiotoxicity. Pain was the commonest symptom (5/8), followed by palpitation and sweating. Three patients developed EKG abnormalities and 1 went into cardiogenic shock. Time to toxicity ranged from 18 to 30 h (mean 24 +/- 3.7 h) and serial cardiac enzyme levels remained normal in all patients. The symptoms reversed immediately on cessation of the treatment in most of the patients (7/8). Time to recovery ranged from 5 to 60 min (mean 19.28 +/- 19.6 min). There was no recorded death due to toxicity. We conclude that 5-Fu infusion is associated with a significant risk of symptomatic cardiotoxicity. Concomitant chemotherapeutic agents, received by all the affected patients, may have a contributory effect too. Cardiotoxicity seems to be completely reversible, particularly in patients without underlying cardiac disease. The patients should be informed about the symptoms and the condition recognised and managed immediately.
据报道，5-氟尿嘧啶（5-FU）治疗引起的心脏毒性范围从无症状的心电图异常到致命性心肌梗死。我们报告了一项前瞻性研究，对100例连续接受5-FU输注联合其他化疗药物或单独使用5-FU治疗不同恶性肿瘤的患者进行研究，目的是识别出现有症状心脏毒性的患者。排除有心脏病史、心电图异常或心肌酶水平异常的患者。在整个输注期间对患者进行观察，对无症状患者每日进行心电图检查，对出现心脏毒性的患者进行监测直至症状消失24小时。8例患者出现提示心脏毒性的症状。疼痛是最常见的症状（5/8），其次是心悸和出汗。3例患者出现心电图异常，1例发生心源性休克。出现毒性的时间为18至30小时（平均24±3.7小时），所有患者的系列心肌酶水平均保持正常。大多数患者（7/8）在停止治疗后症状立即缓解。恢复时间为5至60分钟（平均19.28±19.6分钟）。没有因毒性导致死亡的记录。我们得出结论，5-FU输注与有症状心脏毒性的显著风险相关。所有受影响患者同时接受的化疗药物可能也有促成作用。心脏毒性似乎完全可逆，尤其是在没有基础心脏病的患者中。应告知患者这些症状，并立即识别和处理这种情况。
