Fatal myocardial infarction potentially induced by paclitaxel

OBJECTIVE: To report a case of a fatal myocardial infarction (MI) possibly induced by paclitaxel in a patient with metastatic breast cancer. CASE SUMMARY: A 67-year-old African-American woman with metastatic breast cancer was treated with a paclitaxel infusion. Fifteen hours into the 24-hour continuous infusion, the patient developed tachypnea respiratory distress, and chest pain. Paciltaxel infusion was discontinued. Electrocardiogram findings revealed ST elevation in leads 2, 3, and aVF acutely. The cardiac enzymes were abnormal and the echocardiogram changes showed severe global left ventricular dysfunction consistent with acute MI. The patient died 13 hours after stopping the paclitaxel infusion. DISCUSSION: Cardiac adverse effects of paclitaxel have been described in preliminary studies. Paclitaxel-induced cardiac abnormalities are usually described as asymptomatic and transient. MI secondary to paclitaxel infusion has rarely been reported. The mechanism by which paclitaxel causes cardiac abnormalities, especially myocardial damage, is not well understood. CONCLUSIONS: Myocardial damage secondary to paclitaxel infusion is a serious and life-threatening adverse effect. Caution should be exercised in all patients treated with paclitaxel until more information regarding risk factors is available.