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Negative chronotropic effects and coronary ischaemic abnormalities following thalidomide therapy
Ali Ali1, Sandeep S Hothi, Andrew Thompson
1Northampton General Hospital, Northampton, UK. rbukharian@hotmail.com
Cardiology
|April 26, 2013
Summary
Thalidomide, reintroduced for cancer treatment, may cause coronary artery spasm and bradycardia. This case report highlights these potential cardiac adverse effects, necessitating vigilance from oncologists and cardiologists.
Area of Science:
- Cardiology
- Oncology
- Pharmacology
Background:
- Thalidomide, known for teratogenic effects, is re-entering clinical use for conditions like multiple myeloma.
- Adverse effects of thalidomide are still being documented as its clinical application expands.
Observation:
- A 65-year-old male with multiple myeloma developed severe chest pain, bradycardia with sinus pauses, and ST-elevation myocardial infarction-like ECG changes during thalidomide-based chemotherapy.
- Coronary angiography revealed no obstructive coronary artery disease, suggesting coronary artery spasm as the cause of ischemic symptoms.
- The patient required temporary pacing for bradycardia and was treated with nifedipine after thalidomide omission, with no recurrence of cardiac symptoms over 24 months.
Findings:
- This is the first reported case of coronary artery spasm associated with thalidomide use.
- Bradycardia and coronary artery spasm are identified as potential cardiac adverse events linked to thalidomide therapy.
- The precise mechanism of thalidomide-induced cardiac side effects remains unclear, with potential autonomic, autocoid, and paracrine pathways implicated.
Implications:
- Oncologists and cardiologists must be aware of the potential for thalidomide to induce coronary artery spasm and bradycardia.
- This case underscores the importance of monitoring cardiac function in patients receiving thalidomide-based treatments.
- Further research is needed to elucidate the mechanisms underlying thalidomide's cardiac toxicity.
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