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5-Fluorouracil–Induced Microvascular Vasospasm Diagnosed by Coronary Functional Testing

Year: 2025

Type: article

Abstract: BACKGROUND: The 5-fluorouracil (5-FU) component of 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy is a known cause of coronary vasospasm. Diagnosis can be difficult, often leading to interruption of chemotherapy. CASE SUMMARY: A 53-year-old man with a history of colorectal cancer developed new-onset angina after initiation of FOLFOX chemotherapy. He underwent a left heart catheterization, coronary functional testing (CFT), and acetylcholine (ACh) provocation. ACh provocation elicited similar angina, consistent with microvascular vasospasm. This prompted initiation of calcium-channel blockers and adjustments to chemotherapy administration, preventing further angina. DISCUSSION: CFT with ACh provocation should be considered in patients undergoing chemotherapy with 5-FU. As 5-FU coronary vasospasm is often transient, ACh provocation can identify patients who would benefit from calcium-channel blockers and changing 5-FU administration from continuous to bolus dosing. TAKE-HOME MESSAGE: This case highlights the utility of CFT in identifying and guiding treatment in suspected cases of 5-FU-associated coronary vasospasm.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105137

Authors: Rimsha Rana, Ryan L. Wallace, Ron Waksman, Hayder D. Hashim, Brian C. Case

Institutions: MedStar Georgetown University Hospital, MedStar Washington Hospital Center

Language: English

Topic: Chemotherapy-induced cardiotoxicity and mitigation

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850