5‐fluorouracil‐induced bradycardia: A case report
Keywords:
5-Fluorouracil, antimetabolite, chemotherapy, cardiotoxicity, bradycardiaAbstract
Background and Objective: Cardiotoxicity is one of the adverse effects associated with 5-fluorouracil (5-FU) based regimen. Diverse abnormal clinical manifestations such as angina, palpitation, dyspnea, myocardial infarction, cardiogenic shock and cardiac arrest have been linked to 5-FU. Although asymptomatic electrocardiogram (ECG) abnormalities were presented, the identify of bradycardia was rarely reported. This case report aimed to describe the case of asymptomatic bradycardia after receiving 5-FU treatment.
Case presentation: We report a case of 47-year-old female who was previously diagnosed with mucinous adenocarcinoma of cervix clinical stage IVB 9 months and had a history of structural heart disease. Her cardiac condition, which was investigated before chemotherapy treatment, showed stable disease. However, during 5-FU palliative chemotherapy (Cycle 1), she developed asymptomatic bradycardia on the third day of cycle with 5-FU 1000 mg/m2. After occurrence of the cardiac event, 5-FU was discontinued, and reintroduction of 5-FU was not performed.
Conclusion: 5-FU induced bradycardia is an unusual cardiac event. In patients with history of cardiovascular disease, evaluating cardiac disease and cardiovascular risks should be performed before treatment initiation. Moreover, close monitoring with ECG or a 12-leads Holter monitoring are necessary as well. 5-FU should be immediate discontinued after the event is suspected. Reintroduction of 5-FU could be performed in some patients without serious problems. However, risk-benefit assessment should be done before performing rechallenge therapy.
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