Assuntos
Humanos , Feminino , Idoso , Doença da Artéria Coronariana/fisiopatologia , Doenças Cardiovasculares/diagnóstico por imagem , Anastomose de Artéria Torácica Interna-Coronária/reabilitação , Angina Pectoris/induzido quimicamente , Angiografia Coronária/métodos , Isquemia Miocárdica/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Ecocardiografia sob Estresse/efeitos dos fármacosRESUMO
Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.
Assuntos
Idoso de 80 Anos ou mais , Humanos , Masculino , Angina Pectoris/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bloqueadores dos Canais de Cálcio/administração & dosagem , Neoplasias do Colo/tratamento farmacológico , Angiografia Coronária , Vasoespasmo Coronário/induzido quimicamente , Stents Farmacológicos , Eletrocardiografia , Fluoruracila/administração & dosagem , Leucovorina/administração & dosagem , Nifedipino/administração & dosagem , Nitroglicerina/administração & dosagem , Compostos Organoplatínicos/administração & dosagem , Intervenção Coronária Percutânea/instrumentação , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento , Vasodilatadores/administração & dosagemRESUMO
Adenosine has recently been demonstrated to be a mediator of angina in human beings. The present study was undertaken to document the presence or absence of myocardial ischaemia on clinical, haemodynamic, electrocardiographic and metabolic evidences after intracoronary administration of adenosine. Fifteen patients with chronic stable angina (12 males and 3 females), positive exercise stress test and documented significant stenosis of the left anterior descending coronary artery (LAD) were included in the study. The surface and intracoronary electrocardiograms (ECGs), pulmonary artery diastolic pressure and coronary sinus lactate levels were monitored at baseline and after intracoronary administration of adenosine in all patients. Adenosine was administered intracoronary in doses of 1000-8000 microgram depending on the provocation of chest pain. Typical angina was observed in all patients. There were no signs of ischaemia on surface or intracoronary ECG. There was no statistically significant difference between the pulmonary artery diastolic pressure and coronary sins lactate levels at baseline and post-adenosine administration (p > 0.05). It is concluded that intracoronary administration of adenosine produces chest pain in patients with chronic stable angina by mechanism other than myocardial ischaemia.