[Angina pectoris and ST-elevation after chemotherapy with 5-fluorouracil]

We report on the case of a 64 year old male who received chemotherapy for a metastatic squamous cell carcinoma of the oropharynx. The chemotherapeutic regimen consisted of 5-fluorouracil (5-FU) and cisplatin. Six hours after completion of the first 24 h continuous infusion of 5-FU, the patient developed severe chest pain accompanied by vegetative symptoms and a pronounced ST-elevation of the precordial leads. Under the suspicion of an acute anterior myocardial infarction an immediate coronary angiogram was performed, demonstrating a total occlusion of the left anterior descending (LAD) coronary artery close to the left main stem. The other coronary arteries appeared smooth. After the intracoronary administration of nitroglycerine, the LAD reopened spontaneously without any residual stenosis, paralleled by complete relief of all symptoms. Therefore, 5-FU induced coronary spasm was diagnosed. After initial therapy with intravenous nitrate followed by oral calcium channel blocker, the patient remained free of symptoms and no rise in cardiac enzymes were noted. The chemotherapeutic regimen was changed to cisplatin plus docetaxel. No new attacks of chest pain occurred and the antivasospastic therapy could be stopped without further events.