SHM Converge Scientific Abstract ePoster Gallery-An Antidote for the Heart: Uridine Triacetate Treatment of 5-Fu Mediated Cardiotoxicity

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A 49-year-old man with primary sclerosing cholangitis and newly diagnosed locally advanced cholangiocarcinoma developed severe cardiotoxicity shortly after starting outpatient FOLFOX chemotherapy, which includes 5-fluorouracil (5-FU). Within one day of treatment, he presented to the emergency department with chest pain radiating to the left arm and shortness of breath. Initial evaluation showed elevated and rising troponins, diffuse ST-segment elevations on EKG, and a markedly reduced ejection fraction on transthoracic echocardiogram. Because his risk for coronary artery disease was low, cardiac CT angiography was performed and showed no atherosclerosis.<br /><br />His condition worsened within six hours, progressing to hypotension, tachycardia, cool extremities, elevated lactate, and low ScvO2, consistent with cardiogenic shock. He was started on dobutamine and transferred to the cardiac care unit, where uridine triacetate was initiated. 5-FU was discontinued.<br /><br />After three days of therapy, cardiac MRI showed improving function. Repeat echocardiography six days later and again six months later demonstrated recovery of left ventricular ejection fraction to 50–55%. The patient was ultimately switched to a non-5-FU chemotherapy regimen.<br /><br />The case highlights that 5-FU cardiotoxicity, although uncommon, can range from ECG changes and chest pain to cardiogenic shock and death. Early recognition, immediate discontinuation of 5-FU, and supportive cardiac care are essential. In selected severe or early-onset cases, uridine triacetate may serve as an effective antidote and improve outcomes.

Asset Subtitle

Kaitlyn C. Dykes

Meta Tag

Author List Abra Guo, Ali Alqahtani, Emma Ringwelski, Kaitlyn C. Dykes, Maneesh Jain, Yiannis Dimopoulos

Category Clinical Vignettes

Concept 5-Fluorouracil Cardiotoxicity

Concept Cardiac Symptom

Concept 5-Fluorouracil Discontinuation

Concept Uridine Triacetate

Concept Fluoropyrimidine Chemotherapy

Distinguished Finalist

Presenter Organization Georgetown University Hospital, MedStar

Presenting Author Kaitlyn C. Dykes

Track Adult

Keywords

5-fluorouracil cardiotoxicity

FOLFOX chemotherapy

cholangiocarcinoma

primary sclerosing cholangitis

cardiogenic shock

troponin elevation

ST-segment elevations

left ventricular ejection fraction

uridine triacetate

cardiac MRI recovery

5-Fluorouracil Cardiotoxicity

Cardiac Symptom

5-Fluorouracil Discontinuation

Uridine Triacetate

Fluoropyrimidine Chemotherapy