Journal of Digestive Cancer Research

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
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A Case of Coronary Vasospasm in a Patient with Esophageal Cancer Receiving Chemotherapy with 5-fluorouracil

5-fluorouracil 사용 중인 식도암 환자에서 발생한 관상동맥연축

  • Jin Wook Lee (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Moo In Park (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Seun Ja Park (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Won Moon (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Sung Eun Kim (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Jae Hyun Kim (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Kyoungwon Jung (Department of Internal Medicine, Kosin University College of Medicine)
  • 이진욱 (고신대학교 의과대학 내과학교실) ;
  • 박무인 (고신대학교 의과대학 내과학교실) ;
  • 박선자 (고신대학교 의과대학 내과학교실) ;
  • 문원 (고신대학교 의과대학 내과학교실) ;
  • 김성은 (고신대학교 의과대학 내과학교실) ;
  • 김재현 (고신대학교 의과대학 내과학교실) ;
  • 정경원 (고신대학교 의과대학 내과학교실)
  • Received : 2017.05.31
  • Accepted : 2017.06.03
  • Published : 2017.06.30
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Abstract

5-Fluorouracil (5-FU) has been widely used in the treatment of various solid tumors. However, 5-FU cardiotoxicity is being reported with increasing frequency. The main symptom of cardiotoxicity is chest pain at rest with ischemic electrocardiographic changes. Up until now, the underlying mechanism has been suspected to be coronary artery spasm. However, this chest pain associated with 5-FU has several characteristics that are incompatible with coronary artery spasm; eg, inefficacy of calcium-channel blocker and a slow increase in cardiac enzyme levels. We experienced a case of 5-FU-induced cardiotoxicity which showed clinical findings consistent with acute myocardial infarction. Based on the clinical findings, coronary angiography, and no stenosis was noted. However, we concluded that the cardiotoxicity in this case was due to ischemia caused by coronary artery spasm. Because vasodilatator was effective and secondary attack was followed.

5-FU로 인한 심장독성은 드물지만 협심증, 심근경색, 심지어 심장 돌연사까지 유발할 수 있다. 그러므로 약물치료를 계획하기 전 환자의 기저 심질환 여부를 정확히 평가해야 하며, 지연반응으로 인해 약물 투여와 증상 발생의 시간적 간격이 늘어날 수도 있으므로 증상과 EKG에서의 변화가 명확하다면 5-FU로 인한 관상동맥의 일시적인 연축으로 볼 수 있다. 심장효소의 상승과 관상동맥 조영술에서 심혈관의 협착 소견이 없더라도 약물을 중단하고 칼슘통로차단제 등의 혈관확장제를 사용하여야 한다. 그리고 재발의 위험성이 매우 높기 때문에 재투여는 피해야 한다.

Keywords

References

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