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Published on: February 3, 2021
5-Fluorouracil-Induced Microvascular Vasospasm Diagnosed by Coronary Functional Testing
Rimsha Rana1, Ryan L Wallace2, Ron Waksman2
1Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA.
Background:
The 5-fluorouracil (5-FU) component of 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy is a known cause of coronary vasospasm. Diagnosis can be difficult, often leading to interruption of chemotherapy.
Case Summary:
A 53-year-old man with a history of colorectal cancer developed new-onset angina after initiation of FOLFOX chemotherapy. He underwent a left heart catheterization, coronary functional testing (CFT), and acetylcholine (ACh) provocation. ACh provocation elicited similar angina, consistent with microvascular vasospasm. This prompted initiation of calcium-channel blockers and adjustments to chemotherapy administration, preventing further angina.
Discussion:
CFT with ACh provocation should be considered in patients undergoing chemotherapy with 5-FU. As 5-FU coronary vasospasm is often transient, ACh provocation can identify patients who would benefit from calcium-channel blockers and changing 5-FU administration from continuous to bolus dosing.
Take-Home Message:
This case highlights the utility of CFT in identifying and guiding treatment in suspected cases of 5-FU-associated coronary vasospasm.
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