The patient was subsequently given one cycle of capecitabine, which she tolerated. Repeat echocardiogram six weeks later revealed normalization of left ventricular function with an EF of 55–60%. The patient was seen by a cardio-oncologist and was placed on a beta blocker and ACE inhibitor. A diagnosis of 5-FU induced cardiomyopathy was made. Subsequent coronary CT revealed normal coronaries with no stenosis. One month earlier the patient had an unremarkable echocardiogram. Echocardiogram on the following day revealed severely reduced left ventricular function with an ejection fraction (EF) of 20–25% with severe hypokinesis of the entire left wall. Initially, cardiac biomarkers indicated a mildly elevated troponin I at the level of 0.05 ng/ml (normal range < 0.04 ng/ml), with a peak level of 0.14 ng/ml at 48 h. Electrocardiography (ECG) revealed hyperacute T waves with no ST elevation or depression (Fig. Approximately 12 h into receiving the first infusional dose of 5-FU, the patient developed progressive substernal chest pain and shortness of breath. 5-FU was given as bolus at 400 mg/m2, followed by 1200 mg/m2/day continuous infusion over 46 h. After undergoing laparoscopic ileocolectomy, the patient was started on adjuvant chemotherapy with modified FOLFOX6 (fluorouracil, leucovorin, and oxaliplatin). A 47-year-old woman with no known history, or risk factors, of cardiac disease, was diagnosed with stage III colon adenocarcinoma.
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