Subject(s)
Humans , Female , Aged , Coronary Artery Disease/physiopathology , Cardiovascular Diseases/diagnostic imaging , Internal Mammary-Coronary Artery Anastomosis/rehabilitation , Angina Pectoris/chemically induced , Coronary Angiography/methods , Myocardial Ischemia/diagnostic imaging , Coronary Stenosis/diagnostic imaging , Echocardiography, Stress/drug effectsABSTRACT
Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.
Subject(s)
Aged, 80 and over , Humans , Male , Angina Pectoris/chemically induced , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Calcium Channel Blockers/administration & dosage , Colonic Neoplasms/drug therapy , Coronary Angiography , Coronary Vasospasm/chemically induced , Drug-Eluting Stents , Electrocardiography , Fluorouracil/administration & dosage , Leucovorin/administration & dosage , Nifedipine/administration & dosage , Nitroglycerin/administration & dosage , Organoplatinum Compounds/administration & dosage , Percutaneous Coronary Intervention/instrumentation , Recurrence , Severity of Illness Index , Treatment Outcome , Vasodilator Agents/administration & dosageABSTRACT
Adenosine has recently been demonstrated to be a mediator of angina in human beings. The present study was undertaken to document the presence or absence of myocardial ischaemia on clinical, haemodynamic, electrocardiographic and metabolic evidences after intracoronary administration of adenosine. Fifteen patients with chronic stable angina (12 males and 3 females), positive exercise stress test and documented significant stenosis of the left anterior descending coronary artery (LAD) were included in the study. The surface and intracoronary electrocardiograms (ECGs), pulmonary artery diastolic pressure and coronary sinus lactate levels were monitored at baseline and after intracoronary administration of adenosine in all patients. Adenosine was administered intracoronary in doses of 1000-8000 microgram depending on the provocation of chest pain. Typical angina was observed in all patients. There were no signs of ischaemia on surface or intracoronary ECG. There was no statistically significant difference between the pulmonary artery diastolic pressure and coronary sins lactate levels at baseline and post-adenosine administration (p > 0.05). It is concluded that intracoronary administration of adenosine produces chest pain in patients with chronic stable angina by mechanism other than myocardial ischaemia.