Takotsubo Cardiomyopathy in a Patient Undergoing 5-Fluorouracil Infusion: Considerations for Folinic Acid, 5-Fluorouracil, and Oxaliplatin (FOLFOX) Cardiotoxicity and Rechallenge

Takotsubo cardiomyopathy (TCM) is a rare but reversible cause of transient ventricular dysfunction, often triggered by sympathetic stimulation from physical or emotional stress. Patients with a history of TCM undergoing cardiotoxic chemotherapy such as FOLFOX (folinic acid, 5-fluorouracil (5-FU), and oxaliplatin) require vigilant monitoring due to potential cardiac complications, including coronary vasospasm and direct myocardial toxicity. We present a case of progressively worsening TCM diagnosed via coronary angiography and left ventriculography three days after a patient received their first FOLFOX infusion for sigmoid adenocarcinoma. The cardiomyopathy resolved with conservative management, and one month later, the patient was admitted for a monitored FOLFOX rechallenge in the telemetry unit, which she tolerated well. This case highlights the importance of cardiac surveillance in patients with prior TCM requiring chemotherapy and discusses strategies for minimizing cardiotoxic risk during 5-FU rechallenge.