5-Fluorouracil-associated coronary vasospasm with takotsubo-like myocardial dysfunction: A case report

Fluorouracil (5-FU) is frequently used in chemotherapy for several cancers, but adverse effects such as electrocardiography (ECG) ST-T changes and vascular spasms have been reported. Here, we present a case in which 5-FU triggered coronary vasospastic angina and takotsubo syndrome. A 65-year-old woman was admitted to our hospital for treatment of esophageal adenocarcinoma and initiated on 5-FU, leucovorin, and oxaliplatin. Three days after administration, she experienced chest pain that resolved spontaneously. On the fifth day, she was referred to our department. ECG showed ST-segment elevation in leads II, III, and aV_F, with T-wave inversion in leads I, aV_L, and V_1-6. Echocardiography revealed wall motion abnormalities predominantly at the apex. Cardiac computed tomography showed no significant coronary artery stenosis. An acetylcholine provocation test was performed, revealing multi-vessel spasm, leading to a diagnosis of coronary vasospastic angina. Coronary vasodilators were initiated, and the chemotherapy regimen was changed to discontinue 5-FU. The patient experienced no recurrence of chest pain, and improvements were observed in both echocardiographic and ECG findings. Reports of takotsubo syndrome caused by 5-FU are rare, and its mechanism remains unclear. In this case, the presence of coronary vasospastic angina suggests that it may have contributed to the development of takotsubo syndrome.

5-Fluorouracil (5-FU) is commonly used for various cancers. 5-FU has been reported to cause side effects such as chest pain, changes in the electrocardiogram, and coronary spastic angina. We experienced vasospastic coronary angina and takotsubo syndrome induced by 5-FU. The mechanism of takotsubo syndrome may be related to ischemia caused by coronary spasm.