Diagnostic features and literature review of acute coronary syndrome induced by fluorouracil
Wang Chunhui1， Li Jing1， Wu Wei1， Lin Jinyi2， Xu Yuchen3， Lyu Qianzhou1， Cheng Leilei3
1Department of Pharmacy, 2Department of Cardiology, 3Department of Echocardiography, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
Abstract：ObjectiveTo explore the diagnostic features of acute coronary syndrome induced by fluorouracil. MethodsA case of acute coronary syndrome after fluorouracil chemotherapy who was treated for colon cancer in the oncology department of Zhongshan Hospital Affiliated to Fudan University was retrospectively analyzed, the relevant literatures were reviewed. ResultsA 60-year-old male colon cancer patient combined with coronary heart disease who underwent percutaneous coronary intervention accepted the first cycle adjuvant chemotherapy FOLFOX (fluorouracil, calcium folinate, oxaliplatin) regimen. On the 14th day after chemotherapy, he developed chest tightness, persistent chest pain, inability to lie flat, sitting breathing and shortness of breath. Both serum cardiac troponin (cTnT) level (0687μg/L) and Nterminal pro B-type natriuretic (NT-proBNP) level (7128ng/L) increased significantly, ECG revealed persistent myocardial ischemia changes and pulmonary CTA showed no definite embolism signs. Excluding other pathological and drug factors, acute coronary syndrome caused by fluorouracil was considered. After the symptomatic supportive treatment, the levels of cTnT and NT-proBNP reduced gradually while the patient no longer complained of chest tightness or chest pain. The surveillance of ECG and TTE during and after TOMOX(oxaliplatin, raltitrexed) regimen had no difference and the level of cTnT decreased to the normal. ConclusionPatients receiving fluorouracil should be monitored carefully of drug-induced cardiotoxicity, such as acute coronary syndrome, to ensure the smooth progress of chemotherapy.
