Chemotherapy with 5-fluorouracil (5-FU, prodrug capecitabine) may be associated with sudden death.
5-fluorouracil toxicity may include:
(1) toxic myocarditis
(2) coronary vasospasm, with myocardial ischemia
(3) cardiac arrhythmia
(4) pericarditis
(5) QTc prolongation
(6) coronary dissection
Risk factors for cardiotoxicity:
(1) overdose
(2) failure to treat with uridine triacetate, the antidote to 5-FU toxicity
(3) pharmacogenetic variant
(4) pre-existing cardiovascular disease
(5) older age
(6) concurrent therapy with other cardiotoxic medications
(7) continuous infusion
(8) continued 5-FU therapy after onset of cardiac findings
Clinical features:
(1) angina
(2) dyspnea and/or heart failure
(3) hypotension
(4) palpitations
(5) bradycardia
(6) syncope
(7) elevated serum troponin
(8) elevated serum BNP
ECG changes:
(1) ST depression or elevation
(2) T wave inversion
(3) supraventricular or ventricular tachycardia
Diagnosis of sudden death:
(1) history of recent 5-FU therapy
(2) any clinical evidence of cardiotoxicity
(3) any pathologic evidence of cardiac injury
(4) exclusion of other causes
