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Dr. Mete ALPASLAN
5-fluorouracil (5-FU), Capecitabine and the ECG
5-fluorouracil (5-FU)
is the third most commonly used chemotherapeutic agent in the treatment of solid malignancies across the world.
is the second most common chemotherapeutic drug associated with cardiotoxicity after anthracyclines, which can manifest as chest pain, acute coronary syndrome/myocardial infarction or death.
The main symptom of cardiotoxicity is chest pain at rest with ischemic electrocardiographic changes.
Capecitabine is an oral prodrug of fluorouracil.
ECG changes that may be observed in patients under 5-FU therapy
ST segment elevation.
Bradycardia.
T wave inversion.
Prolonged QT interval.
Torsades-de-pointes VT.
Atrial fibrillation.
Frequent ventricular premature contractions.
Prolonged PR interval.
References
Jpn Circ J 1995;59:303-307.
Ther Adv Med Oncol 2018;10: 1758835918780140.
J Cardiovasc Med (Hagerstown) 2006;7(8):637-640.
Intern Med J 2010;40(4):303-307.
J Cancer Res Ther 2007;3:169-171.
Chemotherapy 2011;57(5):381-387.
ECG 1a. The ECG above belongs to a 58 years-old woman with colorectal carcinoma on 5-FU chemotherapy.
She presents to the Emergency Department with chest pain, diaphoresis and shortness of breath.
At first glance, increased T wave amplitude in leads II and aVF suggest hyperacute T waves.
Dr. Salim R. Rezaie has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1b. The ECG above belongs to the same woman. It was recorded after sublingual nitroglycerine.
Now, she does not complain of chest pain and hyperacute T waves in inferior leads have disappeared.
Dr. Salim R. Rezaie has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1c. The ECG above belongs to the same woman.
It was recorded when her chest pain returned, shortly after the ECG 1b.
Her cardiac Troponin level was normal.
She underwent coronary angiography which showed normal coronary arteries.
Coronary vasospasm induced ST segment and T wave changes may be observed in patients under 5-FU therapy.
Dr. Salim R. Rezaie has donated the above ECG to our website.
Click here for a more detailed ECG
is the third most commonly used chemotherapeutic agent in the treatment of solid malignancies across the world.
is the second most common chemotherapeutic drug associated with cardiotoxicity after anthracyclines, which can manifest as chest pain, acute coronary syndrome/myocardial infarction or death.
The main symptom of cardiotoxicity is chest pain at rest with ischemic electrocardiographic changes.
Capecitabine is an oral prodrug of fluorouracil.
ECG changes that may be observed in patients under 5-FU therapy
ST segment elevation.
Bradycardia.
T wave inversion.
Prolonged QT interval.
Torsades-de-pointes VT.
Atrial fibrillation.
Frequent ventricular premature contractions.
Prolonged PR interval.
References
Jpn Circ J 1995;59:303-307.
Ther Adv Med Oncol 2018;10: 1758835918780140.
J Cardiovasc Med (Hagerstown) 2006;7(8):637-640.
Intern Med J 2010;40(4):303-307.
J Cancer Res Ther 2007;3:169-171.
Chemotherapy 2011;57(5):381-387.
ECG 1a. The ECG above belongs to a 58 years-old woman with colorectal carcinoma on 5-FU chemotherapy.
She presents to the Emergency Department with chest pain, diaphoresis and shortness of breath.
At first glance, increased T wave amplitude in leads II and aVF suggest hyperacute T waves.
Dr. Salim R. Rezaie has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1b. The ECG above belongs to the same woman. It was recorded after sublingual nitroglycerine.
Now, she does not complain of chest pain and hyperacute T waves in inferior leads have disappeared.
Dr. Salim R. Rezaie has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1c. The ECG above belongs to the same woman.
It was recorded when her chest pain returned, shortly after the ECG 1b.
Her cardiac Troponin level was normal.
She underwent coronary angiography which showed normal coronary arteries.
Coronary vasospasm induced ST segment and T wave changes may be observed in patients under 5-FU therapy.
Dr. Salim R. Rezaie has donated the above ECG to our website.
Click here for a more detailed ECG