Capecitabine induced coronary vasospasm

Introduction: Capecitabine is used for malignancies of the breast, stomach, pancreas and hepatobiliary system. Capecitabineinduced cardiotoxicity has been well described. However, there are few studies showing capecitabine induced coronary vasospastic angina. Here, we describe a case of capecitabineinduced coronary vasospasm. Case Report: A 54-year-old female with a history of metastatic breast cancer on recently started Capecitabine presented with intermittent chest discomfort on exertion. She was ruled out for the acute coronary syndrome. During the hospital stay, the patient had two further episodes of typical chest pain. She then underwent an exercise stress test and was noted to have ST-segment elevation in the inferolateral leads. Given the positive stress test, a coronary angiography was done, that showed no significant obstructive coronary artery disease. Therefore, a diagnosis of Capecitabine induced coronary spasm was made as a diagnosis of exclusion. Capecitabine was stopped and her chest discomfort resolved. The patient was seen as a follow up two months after this episode and she has been chest painfree after the change in her chemotherapy. Conclusion: Our patient was diagnosed with coronary artery vasospasm secondary to capecitabine and furthermore, discontinuation of capecitabine resolved her symptoms. Recognition of the complication i.e coronary artery vasospasm secondary to capecitabine by the physicians and patients can prevent further adverse events. Also, discontinuation of the drug can further avoid risk for cardiotoxicity.