Managing Chemotherapy-Associated Cardiotoxicity: A Case of 5-Fluorouracil and Mitomycin-Induced Chest Pain

Fluoropyrimidine-based chemotherapy drugs such as 5-fluorouracil (5-FU) have documented cardiotoxic effects from mild chest discomfort to severe ischemia. Early detection of complications is important to ensure patient safety and outcomes. We report the case of a 68-year-old woman with invasive non-keratinizing squamous cell carcinoma who developed recurrent chest pain during chemotherapy with 5-FU and mitomycin. While she had no history of coronary artery disease, she experienced mid-sternal chest pressure radiating to the neck and left arm during both cycles of chemotherapy. Initial presentation showed elevated troponin levels and B-type natriuretic peptide, first-degree atrioventricular node block on electrocardiography (EKG), and preserved left ventricular ejection fraction. She was initially managed with verapamil and Imdur; however, persistent pain during the second cycle required adding ranolazine and a switch from Imdur to Isordil. Following these medication adjustments, she remained symptom-free and was discharged with outpatient follow-up. This case highlights the potential for 5-FU-induced cardiotoxicity and the need for individualized cardiovascular management in patients with an oncologic history. Calcium channel blockers and nitrates can be effective in symptom control, underscoring the importance of early recognition and intervention.