Fluorouracil/folinic acid
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Fluorouracil/folinic acid Vasospasm, leucopenia and cardiac disorders: case report
A 66-year-old man developed vasospasm, cardiac arrest, cardiotoxicity, ventricular fibrillation, monomorphic ventricular tachycardia, ST- segment elevation, ST-segment depression, leucopenia, diastolic dysfunction and non-sustained ventricular tachycardia during treatment with fluorouracil and folinic acid for metastatic colorectal adenocarcinoma [routes, dosages and duration of treatments to reaction onset; not all outcomes stated]. The man started receiving adjuvant chemotherapy with FOLFOX regimen comprising infusions of fluorouracil [5-fluorouracil], folinic acid [Leucovorin] and oxaliplatin. He had been receiving prophylactic therapy with palonosetron and dexamethasone. His medical history included chronic heart failure (NYHA Class-III) with preserved ejection fraction, transient ischaemic attack, hypertension, peripheral vascular disease, persistent atrial fibrillation, chronic iron deficiency anemia and venous thromboembolism. He had undergone end ileostomy and subtotal colectomy. He was a non-smoker and non-alcoholic without recreational drug use. He had no family history of sudden cardiac death or premature coronary artery disease. His regular medications included pravastatin, ondansetron, ferrous sulfate and rivaroxaban [Xarelto]. During the first chemotherapy cycle, he collapsed suddenly during the infusion. Telemetry showed ventricular fibrillation which was converted to monomorphic ventricular tachycardia after direct cardioversion and defibrillation. He was successfully resuscitated with cardiopulmonary resuscitation. An ECG immediately after spontaneous circulation showed atrial fibrillation, ST-elevation in the inferior leads with reciprocal STdepression in the lateral leads. He reported diaphoresis and lightheadedness, denied palpitations, dyspnoea, chest pain, nausea or vomiting. He underwent an emergency cardiac catheterisation. Vital signs revealed hypotension, HR was 74 beats/min, RR was 24 breaths/min and oxygen saturation was 94%. The man’s blood pressure improved with dopamine infusion. Cardiopulmonary physical examination showed an irregular heart rhythm. He had no jugular vein distention, and auscultation revealed clear chest without rales. He had 2+ pulses throughout. Laboratory test revealed mild leucopenia, anaemia, haematocrit of 23.2 and platelets of 233 × 103 /µL. Basic metabolic panel revealed potassium 3.7 mmol/L, sodium 127 mmol/L, bicarbonate 19 mmol/L, blood urea nitrogen (BUN) 26 mg/dL, glucose 142 mg/dL, creatinine 0.8 mg/dL and an estimated glomerular filtration rate (eGFR) of 93.1 mL/min/1.73 m2. His troponin-I and brain natriuretic peptide (BNP) was found to be elevated. Coronary angiogram showed no thrombo-occlusive coronary artery disease. Left ventriculogram showed normal left ventricular systolic function. While on dopamine, cardiac catheterisation revealed clean coronary arteries without significant atherosclerosis. Using pulmonary artery saturation of 79.6% and aortic saturation o
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