SHM Converge Scientific Abstract ePoster Gallery-The Innocnet Coronaries: Coronary Vasospasm Induced by Capecitabine

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This case describes an 89-year-old woman with atrial fibrillation, prior TIA, and stage IV colon cancer who developed chest pain shortly after starting capecitabine (Xeloda). She began having intermittent chest pain one day after initiation, and on the third day presented to the emergency department. Her initial exam, chest X-ray, and troponin were unremarkable, and her first EKG, obtained when she was pain-free, showed normal sinus rhythm without ischemic changes. However, after another episode of chest pain, a repeat EKG showed acute inferior ST-segment elevation, mimicking STEMI, despite persistently negative troponin. Her symptoms improved after aspirin, ticagrelor, and nitroglycerin. Emergent cardiac catheterization revealed only mild coronary artery disease with a patent right coronary artery, and echocardiography showed normal left ventricular function (EF 60%) without wall motion abnormalities.  <br /><br />The most likely diagnosis was capecitabine-induced coronary vasospasm. After capecitabine was held, her symptoms and EKG changes resolved.  <br /><br />The discussion notes that capecitabine is an oral prodrug of 5-fluorouracil, commonly used in colorectal cancer, and that although 5-FU cardiotoxicity is well known, capecitabine-associated coronary vasospasm is rare and underreported. Reported cases often occur within days of starting therapy and may present with angina-like symptoms, transient ST changes, negative troponins, and normal coronary angiography. The proposed mechanism involves endothelial effects leading to endothelin-1 release and vasospasm.  <br /><br />The key takeaway is that clinicians should recognize capecitabine as a potential cause of reversible coronary vasospasm, even in patients without significant coronary disease, and promptly discontinue the drug to prevent further cardiotoxicity.

Asset Subtitle

Hatem Hassaballa

Meta Tag

Author List Hatem Hassaballa, Malek Allababidi, Praveena Jaidev

Category Clinical Vignettes

Concept Capecitabine

Concept Coronary Vasospasm

Concept Cardiotoxicity

Concept Chest Pain

Concept Electrocardiogram

Distinguished Non-Finalist

Presenter Organization University of Illinois at Chicago

Presenting Author Hatem Hassaballa

Track Adult

Keywords

capecitabine

Xeloda

coronary vasospasm

ST-segment elevation

chest pain

cardiotoxicity

5-fluorouracil

atrial fibrillation

colon cancer

normal coronary angiography

Capecitabine

Coronary Vasospasm

Cardiotoxicity

Chest Pain

Electrocardiogram