What the Cardiologist Needs to Consider in the Management of Oncologic Patients with STEMI-Like Syndrome: A Case
Aneta Aleksova1,2, Giulia Gagno1,2, Alessandro Pierri1,2
1Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy.
Insights
Chemotherapy drug 5-Fluorouracil (5-FU) can cause acute coronary syndrome (ACS) mimicking ST-segment elevation myocardial infarction (STEMI). This case highlights the need for cardiologists to recognize drug-induced cardiac events in cancer patients.
Area of Science:
- Cardiology
- Oncology
- Pharmacology
Background:
- ST-segment elevation myocardial infarction (STEMI) requires rapid diagnosis and intervention to minimize myocardial damage and mortality.
- While atherosclerotic plaque rupture is the primary cause of STEMI, a subset of patients present with normal coronary angiography findings.
- Fluoropyrimidines (e.g., 5-Fluorouracil, capecitabine) are widely used chemotherapeutics with known potential for severe cardiac side effects.
Observation:
- A case report details a patient experiencing recurrent chest pain and ST-segment elevation, indicative of acute coronary syndrome (ACS).
- The patient's symptoms were attributed to cardiotoxicity induced by 5-Fluorouracil (5-FU) chemotherapy.
- Emergency coronary angiography revealed no significant coronary stenosis, suggesting a non-atherosclerotic cause for the cardiac event.
Findings:
- 5-Fluorouracil (5-FU) cardiotoxicity can manifest as acute coronary syndrome (ACS) with ST-segment elevation, mimicking STEMI.
- This presentation underscores that cardiac events in cancer patients undergoing chemotherapy may be drug-induced rather than solely due to coronary artery disease.
Implications:
- Cardiologists must be aware of the potential cardiac side effects of chemotherapeutic agents, particularly fluoropyrimidines.
- Increased recognition of drug-induced cardiotoxicity is crucial given the rising global cancer patient population and the prevalent use of fluoropyrimidines.
- Prompt identification of chemotherapy-related cardiac events can guide appropriate management and prevent misdiagnosis of traditional myocardial infarction.
Abstract:
In pre-hospital care, an accurate and quick diagnosis of ST-segment elevation myocardial infarction (STEMI) is imperative to promptly kick-off the STEMI network with a direct transfer to the cardiac catheterization laboratory (cath lab) in order to reduce myocardial infarction size and mortality. Aa atherosclerotic plaque rupture is the main mechanism responsible for STEMI. However, in a small percentage of patients, emergency coronarography does not reveal any significant coronary stenosis. The fluoropyrimidine agents such as 5-Fluorouracil (5-FU) and capecitabine, widely used to treat gastrointestinal, breast, head and neck cancers, either as a single agent or in combination with other chemotherapies, can cause potentially lethal cardiac side effects. Here, we present the case of a patient with 5-FU cardiotoxicity resulting in an acute coronary syndrome (ACS) with recurrent episodes of chest pain and ST-segment elevation.. Our case report highlights the importance of widening the knowledge among cardiologists of the side effects of chemotherapeutic drugs, especially considering the rising number of cancer patients around the world and that fluoropyrimidines are the main treatment for many types of cancer, both in adjuvant and advanced settings.
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