SHM Converge Scientific Abstract ePoster Gallery-A Heart-Stopping Side Effect: Capecitabine-Induced Coronary Vasospasm Presenting as Stemi

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This case report highlights capecitabine-induced coronary vasospasm as a rare but important cardiotoxic side effect that can closely mimic an acute ST-elevation myocardial infarction (STEMI). Capecitabine, a pro-drug of 5-fluorouracil commonly used to treat colorectal and breast cancers, is less often associated with cardiotoxicity than 5-fluorouracil itself, but it can still cause coronary vasospasm, usually within the first week of treatment. This reaction can occur even in patients without prior coronary artery disease.<br /><br />A 62-year-old man with colon cancer developed severe episodic chest pain two days after starting capecitabine. His pain radiated to his back and improved with sublingual nitroglycerin. During one episode, his ECG showed inferolateral ST-segment elevations, and later ECGs demonstrated dynamic changes including ST depressions and return to baseline. Another episode produced recurrent ST elevations, prompting treatment with IV nitroglycerin. Troponin was only mildly elevated. Because of the ECG findings, he was treated as a STEMI and underwent emergent coronary angiography, which showed no obstructive coronary artery disease.<br /><br />He was then diagnosed with capecitabine-induced coronary vasospasm. Capecitabine was stopped, and nifedipine, a dihydropyridine calcium-channel blocker, was started. His symptoms resolved without recurrence.<br /><br />The report emphasizes that capecitabine-induced vasospasm is a diagnosis of exclusion, but should be considered in patients recently started on capecitabine who present with new chest pain and dynamic ECG changes. Although coronary angiography is still needed to rule out obstructive disease, early recognition of this toxicity is essential to guide appropriate management and prevent unnecessary interventions.

Asset Subtitle

Tanvi Brar

Meta Tag

Author List Jaimie Patel, Tanvi Brar

Category Clinical Vignettes

Concept Capecitabine

Concept Vasospasm

Concept Chest Pain

Concept Cardiotoxicity

Concept Coronary Angiography

Distinguished Non-Finalist

Presenter Organization Ohio State University College of Medicine

Presenting Author Tanvi Brar

Track Adult

Keywords

capecitabine

coronary vasospasm

ST-elevation myocardial infarction

cardiotoxicity

chest pain

colon cancer

nitroglycerin

coronary angiography

nifedipine

5-fluorouracil

Capecitabine

Vasospasm

Chest Pain

Cardiotoxicity

Coronary Angiography