SHM Converge Scientific Abstract ePoster Gallery-Scad in a Lynch Syndrome Patient Treated With 5-Fluorouracil

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A woman with a history of differentiated adenocarcinoma of the sigmoid colon, treated with hemicolectomy, bilateral salpingo-oophorectomy, and nine cycles of 5-fluorouracil (5-FU), presented to the emergency department with sudden substernal chest pain and left shoulder pain. Her vital signs were stable, but troponin levels rose markedly, and her ECG showed ST elevations in the inferior leads, prompting urgent cardiac catheterization. The catheterization revealed apical akinesis, non-obstructive coronary artery disease, and a mild dissection of the left anterior descending artery, consistent with spontaneous coronary artery dissection (SCAD).<br /><br />The case highlights the importance of considering SCAD in patients with chest pain who have a history of cancer treatment, especially prior exposure to 5-FU. Although the patient had no major cardiac history and had been in remission for five years, her previous chemotherapy may have contributed to coronary vulnerability. 5-FU is a well-known cardiotoxic agent and can cause free radical injury, endothelial damage, and smooth muscle dysfunction. These effects may lead to vasospasm, myocardial infarction, and wall motion abnormalities such as akinesis.<br /><br />The authors note that cardiotoxic events from 5-FU usually occur early during treatment, making this delayed presentation unusual. They propose that prior 5-FU exposure may have caused long-term smooth muscle dysfunction, predisposing the coronary arteries to intimal tearing and SCAD.

Asset Subtitle

Bridget Dolan

Meta Tag

Author List Bridget Dolan, Kian Parsa, SVETLANA Chernyavsky, Yoshiko Ishisaka

Category Clinical Vignettes

Concept Spontaneous Coronary Artery Dissection

Concept Fluorouracil

Concept Acute Chest Pain

Concept STEMI

Concept Cardiotoxicity

Distinguished Non-Finalist

Presenter Organization Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel

Presenting Author Bridget Dolan

Track Adult

Keywords

spontaneous coronary artery dissection

SCAD

5-fluorouracil

cardiotoxicity

sigmoid colon adenocarcinoma

chest pain

ST elevation myocardial infarction

coronary artery dissection

apical akinesis

chemotherapy

Spontaneous Coronary Artery Dissection

Fluorouracil

Acute Chest Pain

STEMI

Cardiotoxicity