Why the study?
Fluoropyrimidine agents like 5-fluorouracil can cause lethal cardiac side effects mimicking STEMI without coronary stenosis, highlighting the need to increase cardiologist awareness of chemotherapeutic cardiotoxicity.
Cardiologists must be aware of fluoropyrimidine-induced cardiotoxicity, which can mimic STEMI without significant coronary stenosis.
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Clinicians should consider fluoropyrimidine toxicity in STEMI-like presentations without obstruction; this case leaves open incidence and management questions.
In pre-hospital care, an accurate and quick diagnosis of ST-segment elevation myocardial infarction (STEMI) is imperative to promptly kick-off the STEMI network with a direct transfer to the cardiac catheterization laboratory (cath lab) in order to reduce myocardial infarction size and mortality. Aa atherosclerotic plaque rupture is the main mechanism responsible for STEMI. However, in a small percentage of patients, emergency coronarography does not reveal any significant coronary stenosis. The fluoropyrimidine agents such as 5-Fluorouracil (5-FU) and capecitabine, widely used to treat gastrointestinal, breast, head and neck cancers, either as a single agent or in combination with other chemotherapies, can cause potentially lethal cardiac side effects. Here, we present the case of a patient with 5-FU cardiotoxicity resulting in an acute coronary syndrome (ACS) with recurrent episodes of chest pain and ST-segment elevation.. Our case report highlights the importance of widening the knowledge among cardiologists of the side effects of chemotherapeutic drugs, especially considering the rising number of cancer patients around the world and that fluoropyrimidines are the main treatment for many types of cancer, both in adjuvant and advanced settings.
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Aleksova et al. (2021) studied this question.
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