The patient was evaluated by a cardio-oncologist and placed on a beta blocker and ACE inhibitor. It was determined based on the acute onset of symptoms and the lack of previous cardiac symptoms that the patient developed 5-FU induced cardiomyopathy. No previous echocardiogram was available for comparison. Echocardiogram showed severe decreased left ventricular with an ejection fraction of 20–25% with severe global hypokinesis. The cardiac biomarker troponin I was negative. ECG revealed tachycardia and a new left bundle branch block (Fig. After 3 cycles of treatments, she presented to the emergency department with severe dyspnea and cough. 5-FU was given as bolus at 400 mg/m2, followed by 1200 mg/m2/day continuous infusion over 46 h. After palliative laparoscopic end loop colostomy, the patient was started on palliative chemotherapy with modified FOLFOX6. The patient had no history, or risk factors, of cardiac disease. A decision was made no further chemo should be given since the patient was 12 weeks from surgery.Ī 58-year-old woman was diagnosed with stage IV colon adenocarcinoma with metastases. However, she was then admitted to hospital multiple times due to other reasons. The patient was subsequently given one cycle of capecitabine, which she tolerated. Repeat echocardiogram six weeks later revealed normalization of left ventricular function with an EF of 55–60%. The patient was seen by a cardio-oncologist and was placed on a beta blocker and ACE inhibitor. A diagnosis of 5-FU induced cardiomyopathy was made. Subsequent coronary CT revealed normal coronaries with no stenosis.
One month earlier the patient had an unremarkable echocardiogram.
Echocardiogram on the following day revealed severely reduced left ventricular function with an ejection fraction (EF) of 20–25% with severe hypokinesis of the entire left wall. Initially, cardiac biomarkers indicated a mildly elevated troponin I at the level of 0.05 ng/ml (normal range < 0.04 ng/ml), with a peak level of 0.14 ng/ml at 48 h. Electrocardiography (ECG) revealed hyperacute T waves with no ST elevation or depression (Fig.
Approximately 12 h into receiving the first infusional dose of 5-FU, the patient developed progressive substernal chest pain and shortness of breath. After undergoing laparoscopic ileocolectomy, the patient was started on adjuvant chemotherapy with modified FOLFOX6 (fluorouracil, leucovorin, and oxaliplatin). A 47-year-old woman with no known history, or risk factors, of cardiac disease, was diagnosed with stage III colon adenocarcinoma.
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