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Capecitabine-associated coronary vasospasm: a case report
1Norfolk and Norwich University Hospital, Norwich, UK. christina.papadopoulos@imperial.ac.uk
Emergency Medicine Journal : EMJ
|April 25, 2008
Summary
Capecitabine, an oral cancer drug, can cause serious cardiac side effects like chest pain and ECG changes, even at rest. Prompt recognition and treatment of these coronary vasospasm symptoms are crucial for patient safety.
Area of Science:
- Oncology
- Cardiology
- Pharmacology
Background:
- Capecitabine (Xeloda) is an oral prodrug of 5-fluorouracil, widely used for breast and colorectal cancers.
- Cardiac side effects from capecitabine are infrequently reported, often associated with exercise-induced symptoms.
Observation:
- A 43-year-old woman with metastatic sigmoid colon cancer experienced cardiac chest pain and widespread ECG changes at rest, five days after initiating capecitabine therapy.
- The patient had minimal pre-existing cardiac risk factors.
Findings:
- The patient's ischemic cardiac pain and ECG abnormalities resolved with a nitrate infusion.
- Coronary vasospasm is proposed as the likely mechanism underlying the capecitabine-induced cardiac ischemia and ECG changes.
Implications:
- Given the widespread use of capecitabine, emergency and acute care physicians must be aware of its potential cardiac side effects.
- Early recognition and management of capecitabine-induced coronary vasospasm can prevent severe cardiac events.
- This case highlights the importance of considering drug-induced cardiac toxicity in cancer patients presenting with chest pain.
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