A case of cardiogenic shock caused by capecitabine treatment.

BACKGROUND: A 52-year-old woman underwent successful resection of stage IIB primary mucinous adenocarcinoma of the appendix and was started on capecitabine chemotherapy. Five days into the first course, after initially experiencing diarrhea, nausea, vomiting and a transient episode of retrosternal chest pain radiating to the left scapula, she presented to the emergency department with cardiogenic shock. INVESTIGATIONS: Electrocardiography, transthoracic echocardiography, laboratory investigation of cardiac biomarkers, coronary angiography and endomyocardial biopsy. DIAGNOSIS: Capecitabine-induced cardiogenic shock. MANAGEMENT: Supportive treatment with dopamine, milrinone, norepinephrine (noradrenaline) and levosimendan.