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A case of cardiogenic shock caused by capecitabine treatment

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 725–729 (2008)Cite this article

Abstract

Background A 52-year-old woman underwent successful resection of stage IIB primary mucinous adenocarcinoma of the appendix and was started on capecitabine chemotherapy. Five days into the first course, after initially experiencing diarrhea, nausea, vomiting and a transient episode of retrosternal chest pain radiating to the left scapula, she presented to the emergency department with cardiogenic shock.

Investigations Electrocardiography, transthoracic echocardiography, laboratory investigation of cardiac biomarkers, coronary angiography and endomyocardial biopsy.

Diagnosis Capecitabine-induced cardiogenic shock.

Management Supportive treatment with dopamine, milrinone, norepinephrine (noradrenaline) and levosimendan.

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Figure 1: Electrocardiogram recorded at presentation of a patient with capecitabine-induced cardiogenic shock, demonstrating sinus tachycardia, right bundle branch block, and no ST-segment change.
Figure 2: Still frame picture of a transthoracic echocardiogram in apical four-chamber view recorded at presentation of a patient with capecitabine-induced cardiogenic shock, demonstrating dilated left ventricle with an ejection fraction of 24%.
Figure 3: Cardiac biopsy sample from a patient with capecitabine-induced cardiogenic shock, showing a mild degree of lymphocytic infiltration and no definite evidence of myocyte necrosis (hematoxylin and eosin; magnification × 200).
Figure 4: Still frame picture of a transthoracic echocardiogram in apical four-chamber view recorded after recovery in a patient who had experienced capecitabine-induced cardiogenic shock, demonstrating improvement in left ventricle dilation and ejection fraction of 60%.

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Author information

Authors and Affiliations

  1. ACY To, KL Looi, D Damianovich, GB Taylor and D Sidebotham are all Medical Doctors and HD White is Director of Coronary Care and Cardiovascular Research at the Auckland City Hospital, Auckland, New Zealand.,

    Andrew CY To, Khang Li Looi, Dragan Damianovich, Graeme B Taylor, David Sidebotham & Harvey D White

Authors
  1. Andrew CY To
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  2. Khang Li Looi
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  3. Dragan Damianovich
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  4. Graeme B Taylor
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  5. David Sidebotham
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  6. Harvey D White
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Corresponding author

Correspondence to Andrew CY To.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Movie 1

Transthoracic echocardiogram in apical four-chamber view recorded at presentation in a patient with capecitabine-induced cardiogenic shock, demonstrating dilated left ventricle with ejection fraction of 24%. (AVI 872 kb)

Supplementary Movie 2

Transthoracic echocardiogram in apical four-chamber view recorded after recovery in a patient with capecitabine-induced cardiogenic shock, demonstrating improvement in left ventricle and improved ejection fraction of 60%. (AVI 1184 kb)

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To, A., Looi, K., Damianovich, D. et al. A case of cardiogenic shock caused by capecitabine treatment. Nat Rev Cardiol 5, 725–729 (2008). https://doi.org/10.1038/ncpcardio1352

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