Cardiotoxicity of capecitabine may manifest as STEMI with significant left ventricular cardiac dysfunction and recurrent supra-and ventricular arrhythmias -a proposal for optimal diagnosis and treatment

Sebastian Szmit¹Malgorzata Wojciechowska^2*Barbara Sobera²Krystian Szczypiorski²Izabela Poprawa³Dagmara Gralak-Łachowska³Maciej Zarębiński³

• ¹Department of Cardio-Oncology, Centre of Postgraduate Medical Education, Warsaw, Warsaw, Poland
• ²Department of Experimental and Clinical Physiology, Medical University of Warsaw, Warsaw, Poland
• ³Department of Invasive Cardiology, Independent Public Specialist Western Hospital John Paul II, Lazarski University, 05-825 Grodzisk Mazowiecki, Poland, Grodzisk Mazowiecki, Poland

Colorectal cancer is one of the most prevalent cancer globally, representing about 10% of all cancer cases. Due to its prevalence, an important issue is the cardiotoxicity of chemotherapy used in the course of the disease. In this article we present the case of a patient with sigmoid cancer T3N1M0 and rectal cancer T2N0M0 who started postoperative chemotherapy according to the XELOX (CAPOX) regimen (oxaliplatin with capecitabine). A few days later he experienced chemotherapyrelated myocardial injury which presented clinically as an ST-segment elevation myocardial infarction and was further complicated by atrial fibrillation, a severe ventricular arrhythmia, and cardiac arrest. Urgent angiography excluded significant changes in the coronary vessels, but marked reduction in left ventricle systolic function was observed in echocardiography. Takotsubo syndrome and myocarditis were included in the differential diagnosis. Finally, a transient coronary artery spasm was deemed the most probable cause, as temporary ST-segment elevation episodes were noted on the ECG in the initial days of hospitalization. Cardiological treatment resulted in significant improvement of the clinical condition, including improvement of left ventricular systolic function and cessation of arrhythmias. Immediately after leaving the hospital, the patient received Life Vest in the prevention of sudden death and then was qualified for ICD implantation. The importance of the above adjuvant chemotherapy for the prognosis has been confirmed by the fact that after a year of observation the patient experienced a relapse of the cancer disease with metastases to the lungs and peritoneum. Conclusions: This case highlights that severe cardiovascular toxicity from cancer treatment remains a significant issue, critically affecting patient prognosis. Identifying predictors of such complications is essential to enable early prevention. An alternative approach may involve the development of novel anticancer treatments with reduced cardiotoxicity.