Takotsubo cardiomyopathy and Fluorouracil: case report and review of the literature

Capecitabine caused cardiogenic shock through induction of global Takotsubo syndrome

5-Fluorouracil (5-FU) and its oral pro-drug capecitabine are widely used in oncology for the treatment of various solid tumours, including colorectal cancers. Cardiotoxicity to these drugs is not an uncommon adverse effect and has been reported in 1%-18% of patients. Capecitabine has been reported to trigger mid-apical Takotsubo syndrome (TS). We describe here the case of a 55-year-old man who presented with cardiogenic shock and ECG signs of ST-elevation myocardial infarction. The symptoms began 28 h after the commencement of capecitabine adjuvant therapy, following a radical right-sided hemicolectomy for low-differentiated adenocarcinoma of the caecum. Echocardiography showed severe global left ventricular dysfunction. Cardiac magnetic resonance imaging showed no signs of late gadolinium enhancement. These clinical, cardiac image study findings and the course of the disease with full recovery within one week were consistent with global TS triggered by the adjuvant therapy capecitabine and presenting with a life-threatening cardiogenic shock. Moreover, we have demonstrated the speedy dynamic of the left ventricular wall motion abnormality with global TS at presentation and basal (inverted) TS findings 4 days later on.

Takotsubo cardiomyopathy as a delayed complication with a herbicide containing glufosinate ammonium in a suicide attempt: a case report

Background. Glufosinate ammonium has a famous delayed complication as respiratory failure, however, delayed cardiogenic complication is not well known. Objectives. The aim of this study is to report a takotsubo cardiomyopathy as a delayed complication of glufosinate ammonium for suicide attempt. Case Report. A 75-year-old woman ingested about 90 mL of Basta, herbicide for suicide attempt at arousal during sleep. She came to our hospital at twelve hours after ingesting. She was admitted to our hospital for fear of delayed respiratory failure. Actually, she felt down to respiratory failure, needing a ventilator with intubation at 20 hours after ingesting. Procedure around respiratory management had smoothly done with no delay. Her vital status had been stable, however, she felt down to circulatory failure and diagnosed as Takotsubo cardiomyopathy at about 41 hours after ingestion. There was no trigger activities or events to evoke mental and physical stresses. Conclusion. We could successfully manage takotsubo cardiomyopathy resulted in circulatory failure in a patient with glufosinate poisoning for suicide attempt. Takotsubo cardiomyopathy should be taken into consideration if circulatory failure is observed for unexplained reasons.

Recent advances in cardiotoxicity of anticancer therapies

The treatment of two major diseases in the Western world, cancer and heart disease, has improved significantly in recent years. Today, many more cancers are curable than in previous years. Cancer treatment often consists of chemotherapy, radiation therapy, and now also targeted therapy. All three types of treatment can lead to an increased risk of developing or of worsening a pre-existent cardiovascular disease either during the treatment, immediately afterward, or several years after cessation of therapy. Anthracyclines, a class of drugs that are also known as anthracycline antibiotics, and the drug cisplatin have contributed to the success of cancer treatment. However, these agents can cause cardiovascular disease during treatment, and studies have shown that the risk of disease persists for many years after treatment stops. Irradiation contributes significantly to this risk when the cardiovascular system is part of the radiation field. If the targeted therapy also inhibits the genes responsible for maintaining the function of the cardiovascular system, development of cardiovascular symptoms is inevitable. Therefore, it is essential to have a cardiovascular endpoint in trials with targeted therapy. When treatment stops, however, the effect on the cardiovascular system appears to cease, but it is not known whether the long-term risk of developing cardiovascular disease increases. Combined, these factors indicate that close cooperation between oncologists and cardiologists is essential to optimally benefit patients with cancer.