Capecitabine-induced Cardiotoxicity Complicated with Acute Coronary Syndrome and Acute Heart Failure: A Case Report and Review of Scientific Data
Year: 2025
Type: article
Study design: Case Report
Abstract: Prikaz slučaja Case report SAŽetAK: Kardiotoksičnost uzrokovana kapecitabinom razmjerno je česta te može uzrokovati ozbiljne kardiovaskularne komplikacije.Svrha je ovoga prikaza naglasiti važnost uzimanja u obzir potencijalnih toksičnih učinaka kapecitabina te brzog obustavljanja terapije i pravodobnog liječenja svih komplikacija.Predstavit ćemo slučaj 46-godišnjeg muškarca koji je na liječenje primljen s bolima u prsima i elevacijom ST-segmenta u prednjim i lateralnim odvodima, što je upućivalo na akutni infarkt miokarda s elevacijom ST-segmenta.Hitnom je koronarografijom otkrivena prisutnost tromba u prednjoj silaznoj grani lijeve koronarne arterije, nakon čega je provedena perkutana koronarna intervencija.Dva mjeseca prije prijma, bolesnik je bio podvrgnut kirurškom zahvatu zbog karcinoma rektuma.Navedeni simptomi pojavili su se tri dana nakon uvođenja terapije kapecitabinom, koja je odmah nakon prijma prekinuta.Tijekom zahvata nastupilo je kliničko pogoršanje s razvojem kardiogenog šoka.Ehokardiografski pregled proveden nakon zahvata pokazao je ozbiljno smanjenje funkcije lijeve klijetke (ejekcijska frakcija -EF 21 %).Zbog daljnjeg pogoršanja i kardiogenog šoka refraktornog na optimalnu inotropnu i vazopresorsku terapiju, primijenjena je veno-arterijska ekstrakorporalna membranska oksigenacija, a bolesnik je bio priključen na mehaničku ventilaciju.Nakon svih primijenjenih terapijskih mjera bolesnik je klinički stabiliziran.Ekstubiran je nakon dva dana te hemodinamski stabiliziran uz postupno poboljšanje funkcije lijeve klijetke.Kontrolna ehokardiografija devet dana nakon prijma pokazala je EF od 58 %.Ovaj je slučaj primjer uspješnog liječenja potencijalno ozbiljnih kardiotoksičnih komplikacija terapije kapecitabinom u mlađeg bolesnika te ističe nužnost multidisciplinarne suradnje u sličnim kliničkim situacijama.SUMMARY: Capecitabine cardiotoxicity is relatively common and may lead to serios cardiovascular complications.The aim of this case report is to emphasize the importance of considering potential toxic effects, rapid therapy discontinuation, and prompt treatment of all complications.We present a case of a 46-yearold male patient who was admitted to our clinic with chest pain and ST segment elevation in the anterior and lateral leads as a sign of acute ST-segment elevation myocardial infarction.Urgent coronary angiography was performed with the finding of a thrombus in the left anterior descendent coronary artery, and percutaneous coronary intervention was subsequently performed.Two months before admission, the patient had undergone surgery for rectal cancer.The above symptoms started three days after the introduction of treatment with capecitabine, which was discontinued on admission.The patient clinically deteriorated during the procedure, with development of cardiogenic shock.An echocardiography exam performed after the procedure showed severe reduction of left ventricular (LV) function (ejection fraction (EF) 21%).Due to further deterioration and cardiogenic shock refractory to optimal inotropic and vasopressor support, veno-arterial extracorporeal membrane oxygenation support was applied and the patient was placed on mechanical ventilation.After all these treatment measures, the patient clinically stabilized.He was extubated after 2 days and hemodynamically stabilized with gradually improvement of LV function.Control echocardiography after 9 days from admission showed an EF of 58%.Our case is an example of successful treatment of the potential serious cardiotoxic complications of capecitabine therapy in a young patient.The case also emphasizes the necessity of multidisciplinary collaboration in similar clinical scenarios.
Source: Cardiologia Croatica
DOI: 10.15836/ccar2025.76
Institution: Ss. Cyril and Methodius University in Skopje
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408028725