Cardiac ischemia , ST elevation myocardial infarction and ventricular arrhythmia can be side effect of Capecitabine (Xeloda) , through induction of coronary Vasospasm

Awareness and early recognition of possible sides effects can prevent the dangerous cardiac toxicity , and may allow safe continuation of chemotherapy

My patient is a joyful 50 plus years old woman , undergoing successful breast cancer therapy with Xeloda . She presents with typical cardiac angina and palpitations – shown to be ventricular arrhythmia . An angiogram reveals no blocked arteries, ( no coronary disease ) and strong heart pump , ( no heart failure ) . She is in great shape , no other medical problems , with great response to cancer therapy , including Xeloda

Knowing the possible coronary spasm induced by Xeloda , therapy with diltiazem was started, with complete resolution of symptoms , allowing a safe continuation of cancer therapy . Close cardiac monitoring was provided .

Capecitabine (Xeloda) is an oral fluoropyrimidine antimetabolite, which is converted to 5-fluorouracil (5-FU). It is enlisted in the WHO List of Essential Medicines and is currently approved for early-stage and advanced colorectal cancer and metastatic breast cancer. Cardiotoxicity with fluoropyrimidine-based treatment is occasionally observed, and could even be fatal . Although 5-FU is known to cause cardiotoxicity, capecitabine-induced cardiac side effects are poorly described in the literature. 

https://www.ajconline.org/article/S0002-9149(12)01847-4/fulltext

http://www.ijcasereportsandimages.com/archive/article-full-text/100963Z01NS2018

https://journals.sagepub.com/doi/abs/10.1177/1078155211399164?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=oppa