Clinical Case of Myocardial Infarction against the Background of Chemotherapy
This article presents a clinical case of a 64-year-old male with pancreatic adenocarcinoma who developed a large anterior myocardial infarction (MI) during mFOLFIRINOX chemotherapy. The patient experienced angina leading to MI, complicated by a left ventricular aneurysm and apical thrombosis. Coronary angiography revealed ostial occlusion of the left anterior descending artery and multivessel disease. The MI resulted from a mixed mechanism: fluoropyrimidine-induced vasospasm exacerbated by chemotherapy-related anemia, hypovolemia, and underlying atherosclerosis. The patient underwent successful surgical revascularization and aneurysm repair. The authors emphasize that ischemic symptoms during fluoropyrimidine therapy require immediate cardiac evaluation. They advocate for pre-treatment cardiovascular risk stratification and close collaboration between oncologists and cardiologists to prevent severe cardiotoxic complications.
Bolkhovitina O.A., Krivulina T.S., Konstantinova Yu.S., Kuzminova M.N. 2026. Clinical Case of Myocardial Infarction against the Background of Chemotherapy. Challenges in Modern Medicine, 49(3): 287–299 (in Russian). DOI: 10.52575/2687-0940-2026-49-3-287-299. EDN: KSKBGJ
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Список литературы
Виценя М.В., Агеев Ф.Т., Орлова Р.В., Полтавская М.Г., Потиевская В.И. 2023. Практические рекомендации по коррекции кардиоваскулярной токсичности противоопухолевой лекарственной терапии. Практические рекомендации RUSSCO, часть 2 // Злокачественные опухоли. 13: 86–111. doi: 10.18027/2224-5057-2023-13-3s2-2-86-111
Зволинская Е.Ю., Мамедов М.Н., Потиевская В.И., Иванов С.А., Каприн А.Д. 2020. Роль модифицируемых сердечно-сосудистых факторов риска в возникновении онкологических заболеваний. Кардиология. 60(9): 110–121. doi:10.18087/cardio.2020.9.n910
Камышникова Л.А., Ефремова О.А. 2012. Структурно-функциональные изменения миокарда у больных хронической сердечной недостаточностью при лечении спиронолактоном. Клиническая медицина. 90(5): 25.
Ходош Э.М., Ефремова О.А. 2015. Влияние сокращения больничных коек на доступность и качество медицинской помощи. Научный результат. Медицина и фармация. 1(2): 48–61.
Чижова М.А., Болховитина О.А., Совенко Г.Н., Брянцева О.В., Жернакова Н.И. 2011. Оценка эффективности применения препаратов железа у пациентов пожилого возраста, страдающих ишемической болезнью сердца и железодефицитной анемией. Научные ведомости Белгородского государственного университета. Серия: Медицина. Фармация. 4–1(99): 91–94.
Шилов С.Н., Березикова Е.Н., Бобылева Е.Т., Третьяков С.В., Тепляков А.Т., Гракова Е.В., Копьева К.В., Филиппов А.А. 2024. Стратификация риска и первичная профилактика кардиотоксичности химиотерапии // Сибирский журнал клинической и экспериментальной медицины. 39(4): 187–193. doi: 10.29001/2073-8552-2024-39-4-187-193
Dyhl-Polk A., Vaage-Nilsen M., Schou M., Vistisen K.K., Lund C.M., Kümler T., Appel J.M., Nielsen D.L. 2020. Incidence and Risk Markers of 5-Fluorouracil and Capecitabine Cardiotoxicity in Patients with Colorectal Cancer // Acta Oncologica. 59(4): 475–483. doi: 10.1080/0284186X.2019.1711164.
Lu Y., Pan W., Deng S., Dou Q., Wang X., An Q., Wang X., Ji H., Hei Y., Chen Y., Yang J., Zhang H.M. 2023. Redefining the Incidence and Profile of Fluoropyrimidine-Associated Cardiotoxicity in Cancer Patients: A Systematic Review and Meta-Analysis // Pharmaceuticals. 16(4): 510. doi: 10.3390/ph16040510
Lyhne J.D., Hansen V.B., Vestergaard L.D., Hosbond S.E., Busk M., Gnanaganesh M., Maae E., Havelund B.M., Hansen T.F., Timm S., Jensen L.H., Lyhne M.D. 2025. Primary Prevention of Cardiotoxicity in Cancer Patients Treated with Fluoropyrimidines: A Randomized Controlled Trial // Cardio-Oncology. 11(1): 48. doi: 10.1186/s40959-025-00344-3
Lyon A.R., López-Fernández T., Couch L.S., Asteggiano R., Aznar M.C., Bergler-Klein J., Boriani G., Cardinale D., Cordoba R., Cosyns B., Cutter D.J., de Azambuja E., de Boer R.A., Dent S.F., Farmakis D., Gevaert S.A., Gorog D.A., Herrmann J., Lenihan D., Moslehi J., ESC Scientific Document Group. 2022. 2022 ESC Guidelines on Cardio-Oncology Developed in Collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS) // European Heart Journal. 43(41): 4229–4361. doi: 10.1093/eurheartj/ehac244
Murphy S.P., Ibrahim N.E., Januzzi J.L. 2020. Heart Failure with Reduced Ejection Fraction: A Review // JAMA. 324(5) 488–504. doi: 10.1001/jama.2020.10262
Padegimas A., Carver J.R. 2020. How to Diagnose and Manage Patients With Fluoropyrimidine-Induced Chest Pain: A Single Center Approach // JACC: CardioOncology. 2(4): 650–654. doi: 10.1016/j.jaccao.2020.06.012
Raisi-Estabragh Z., Murphy A.C., Ramalingam S., Scherrer-Crosbie M., Lopez-Fernandez T., Reynolds K.L., Aznar M., Lin A.E., Libby P., Cordoba R., Bredsen-Masley C., Wechalekar A., Apperley J., Cheng R.K., Manisty C.H. 2024. Cardiovascular Considerations before Cancer Therapy: Gaps in Evidence and JACC: CardioOncology Expert Panel Recommendations // JACC: CardioOncology. 6(5): 631–654. doi: 10.1016/j.jaccao.2024.07.017
Shanmuganathan J.W.D., Kragholm K., Tayal B., Polcwiartek C., Poulsen L.Ø., El-Galaly T.C., Fosbøl E.L., D'Souza M., Gislason G., Køber L., Schou M., Nielsen D., Søgaard P., Torp-Pedersen C.T., Mamas M.A., Freeman P. 2021. Risk for Myocardial Infarction Following 5-Fluorouracil Treatment in Patients with Gastrointestinal Cancer: A Nationwide Registry-Based Study // JACC: CardioOncology. 3(5): 725–733. doi: 10.1016/j.jaccao.2021.11.001
Zafar A., Drobni Z.D., Lei M., Gongora C.A., Quinaglia T., Lou U.Y., Mosarla R., Murphy S.P., Jones-O'Connor M., Mahmood A., Hartmann S., Gilman H.K., Weekes C.D., Nipp R., Clark J.R., Clark J.W., Blaszkowsky L.S., Tavares E., Neilan T.G. 2022. The Efficacy and Safety of Cardio-Protective Therapy in Patients with 5-FU-Associated Coronary Vasospasm // PLOS ONE. 17(4): e0265767. doi: 10.1371/journal.pone.0265767
References
Vitsenya M.V., Ageyev F.T., Orlova R.V., Poltavskaya M.G., Potievskaya V.I. 2023. Practical Recommendations for the Correction of Cardiovascular Toxicity of Antitumor Drug Therapy. Practical Recommendations RUSSCO, part 2 // Malignant Tumors. 13: 86–111 (in Russian). doi: 10.18027/2224-5057-2023-13-3s2-2-86-111.
Zvolinskaya E.Yu., Mamedov M.N., Potievskaya V.I., Ivanov S.A., Kaprin A.D. 2020. The Role of Modifiable Cardiovascular Risk Factors in the Occurrence of Cancer. Cardiology. 60(9): 110–121 (in Russian). doi:10.18087/cardio.2020.9.n910
Kamyshnikova L.A., Efremova O.A. 2012. Structural and Functional Changes in the Myocardium in Patients with Chronic Heart Failure Treated with Spironolactone. Clinical Medicine. 90(5): 25 (in Russian).
Khodosh E.M., Efremova O.A. 2015. The Impact of Hospital Bed Reduction on the Availability and Quality of Health Care. Research Result. Medicine and Pharmaceutics. 1(2): 48–61 (in Russian).
Chizhova M.A., Bolkhovitina O.A., Sovenko G.N., Bryanceva O.V., Zhernakova N.I. 2011. Evaluation of the Efficiency of Iron Supplements in Elderly Patients with Ischemic Heart Disease and Iron Deficiency Anemia. Scientific Bulletin of Belgorod State University. Series: Medicine. Pharmaceutics. 4–1(99): 91–94 (in Russian).
Shilov S.N., Berezikova E.N., Bobyleva E.T., Tretyakov S.V., Teplyakov A.T., Grakova E.V., Kopyeva K.V., Filippov A.A. 2024. Risk Stratification and Primary Prevention of Chemotherapy-Induced Cardiotoxicity // Siberian Journal of Clinical and Experimental Medicine. 39(4): 187–193 (in Russian). doi: 10.29001/2073-8552-2024-39-4-187-193
Dyhl-Polk A., Vaage-Nilsen M., Schou M., Vistisen K.K., Lund C.M., Kümler T., Appel J.M., Nielsen D.L. 2020. Incidence and Risk Markers of 5-Fluorouracil and Capecitabine Cardiotoxicity in Patients with Colorectal Cancer // Acta Oncologica. 59(4): 475–483. doi: 10.1080/0284186X.2019.1711164.
Lu Y., Pan W., Deng S., Dou Q., Wang X., An Q., Wang X., Ji H., Hei Y., Chen Y., Yang J., Zhang H.M. 2023. Redefining the Incidence and Profile of Fluoropyrimidine-Associated Cardiotoxicity in Cancer Patients: A Systematic Review and Meta-Analysis // Pharmaceuticals. 16(4): 510. doi: 10.3390/ph16040510
Lyhne J.D., Hansen V.B., Vestergaard L.D., Hosbond S.E., Busk M., Gnanaganesh M., Maae E., Havelund B.M., Hansen T.F., Timm S., Jensen L.H., Lyhne M.D. 2025. Primary Prevention of Cardiotoxicity in Cancer Patients Treated with Fluoropyrimidines: A Randomized Controlled Trial // Cardio-Oncology. 11(1): 48. doi: 10.1186/s40959-025-00344-3
Lyon A.R., López-Fernández T., Couch L.S., Asteggiano R., Aznar M.C., Bergler-Klein J., Boriani G., Cardinale D., Cordoba R., Cosyns B., Cutter D.J., de Azambuja E., de Boer R.A., Dent S.F., Farmakis D., Gevaert S.A., Gorog D.A., Herrmann J., Lenihan D., Moslehi J., ESC Scientific Document Group. 2022. 2022 ESC Guidelines on Cardio-Oncology Developed in Collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS) // European Heart Journal. 43(41): 4229–4361. doi: 10.1093/eurheartj/ehac244
Murphy S.P., Ibrahim N.E., Januzzi J.L. 2020. Heart Failure with Reduced Ejection Fraction: A Review // JAMA. 324(5) 488–504. doi: 10.1001/jama.2020.10262
Padegimas A., Carver J.R. 2020. How to Diagnose and Manage Patients With Fluoropyrimidine-Induced Chest Pain: A Single Center Approach // JACC: CardioOncology. 2(4): 650–654. doi: 10.1016/j.jaccao.2020.06.012
Raisi-Estabragh Z., Murphy A.C., Ramalingam S., Scherrer-Crosbie M., Lopez-Fernandez T., Reynolds K.L., Aznar M., Lin A.E., Libby P., Cordoba R., Bredsen-Masley C., Wechalekar A., Apperley J., Cheng R.K., Manisty C.H. 2024. Cardiovascular Considerations before Cancer Therapy: Gaps in Evidence and JACC: CardioOncology Expert Panel Recommendations // JACC: CardioOncology. 6(5): 631–654. doi: 10.1016/j.jaccao.2024.07.017
Shanmuganathan J.W.D., Kragholm K., Tayal B., Polcwiartek C., Poulsen L.Ø., El-Galaly T.C., Fosbøl E.L., D'Souza M., Gislason G., Køber L., Schou M., Nielsen D., Søgaard P., Torp-Pedersen C.T., Mamas M.A., Freeman P. 2021. Risk for Myocardial Infarction Following 5-Fluorouracil Treatment in Patients with Gastrointestinal Cancer: A Nationwide Registry-Based Study // JACC: CardioOncology. 3(5): 725–733. doi: 10.1016/j.jaccao.2021.11.001
Zafar A., Drobni Z.D., Lei M., Gongora C.A., Quinaglia T., Lou U.Y., Mosarla R., Murphy S.P., Jones-O'Connor M., Mahmood A., Hartmann S., Gilman H.K., Weekes C.D., Nipp R., Clark J.R., Clark J.W., Blaszkowsky L.S., Tavares E., Neilan T.G. 2022. The Efficacy and Safety of Cardio-Protective Therapy in Patients with 5-FU-Associated Coronary Vasospasm // PLOS ONE. 17(4): e0265767. doi: 10.1371/journal.pone.0265767