Acute myocardial infarction in a patient with chronic myelocytic leukemia during chemotherapy with hydroxyurea

Cardiac toxicity is a known side effect of chemotherapeutics such as 5-fluorouracil (5-FU) or cisplatin. Chest pain with ECG changes, arrhythmias, acute myocardial infarction (AMI), heart failure and sudden death have been described in the literature.

We report the first case of AMI in a 59-year-old male patient with chronic myelocytic leukemia (CML) during chemotherapy with hydroxyurea. The patient was not affected by prior heart disease and did not reveal any classic risk factors for coronary heart disease. Because of the severe thrombocytopenia (23000/μl), no acetylsalicylic acid (ASA) or clopidogrel were given but low dose heparin (400 U/h). Urgent coronary angiography revealed complete thrombotic occlusion of the proximal left descending coronary artery.

This case reveals that AMI can occur during chemotherapy with hydroxyurea in patients without prior heart disease. The pathogenesis of this phenomenon remains hitherto unclear. Coronary artery spasm, lesions of the endothelium as well as coagulation disorders have been postulated to explain this side effect of hydroxyurea.