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Cardiotoxicity with 5-fluorouracil (5-FU) therapy has been reported to range from asymptomatic EKG abnormalities to fatal myocardial infarction. We report a prospective study in 100 consecutive patients receiving 5-FU infusion in combination with other chemotherapeutic agents or alone for the treatment of different malignancies with the aim of identifying patients who develop symptomatic cardiotoxicity. Patients with a history of cardiac illness, abnormal EKG or cardiac enzyme levels were excluded. Patients were observed during the total period of infusion, daily EKG was performed on asymptomatic patients, those who developed cardiotoxicity were monitored till symptom-free for 24 h. Eight patients developed symptoms suggestive of cardiotoxicity. Pain was the commonest symptom (5/8), followed by palpitation and sweating. Three patients developed EKG abnormalities and 1 went into cardiogenic shock. Time to toxicity ranged from 18 to 30 h (mean 24 +/- 3.7 h) and serial cardiac enzyme levels remained normal in all patients. The symptoms reversed immediately on cessation of the treatment in most of the patients (7/8). Time to recovery ranged from 5 to 60 min (mean 19.28 +/- 19.6 min). There was no recorded death due to toxicity. We conclude that 5-Fu infusion is associated with a significant risk of symptomatic cardiotoxicity. Concomitant chemotherapeutic agents, received by all the affected patients, may have a contributory effect too. Cardiotoxicity seems to be completely reversible, particularly in patients without underlying cardiac disease. The patients should be informed about the symptoms and the condition recognised and managed immediately.

This double-blind randomized cross-over study was conducted to compare the safety and efficacy of high-dose prochlorperazine infusion and dexamethasone (HDPD) with an effective and safe combination of high-dose metoclopramide and dexamethasone (HDMD) in controlling cisplatin-induced emesis. None of the patients entering the study had received any prior chemotherapy. High-dose cisplatin was administered on an inpatient basis. Twenty eligible patients were analyzed based on the assessment made 24 h after the chemotherapy. The parameters compared were severity and duration of nausea and vomiting, severity of retching and side effects. Significantly less vomiting and retching episodes were recorded with HDPD combination. The severity of nausea was also less with this combination. There was no significant difference in the incidence of side effects.

5-fluorouracil cardiotoxicity is increasingly recognized with variable presentation. We report a patient who developed cardiogenic shock due to high-dose 5-fluorouracil infusion (1,000 mg/m2 every 24 hr for 96 hr). There was no evidence of myocardial necrosis. The patient recovered completely without any residual cardiac dysfunction. The exact cause of 5-fluorouracil toxicity remains to be determined. The case highlights the need for careful monitoring of patients who receive high-dose 5-fluorouracil for the development of cardiotoxicity.