IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 20, Issue 4 Ser.1 (April. 2021), PP 20-23 www.iosrjournals.org DOI: 10.9790/0853-2004012023 www.iosrjournal.org 20 | Page Acute Coronary Syndrome - NSTEMI following Paclitaxel administration in patient with Oral Squamous Cell Carcinoma : Case report and Review Dr Deepali Lodha*, Dr Roop Gill*, Dr Vivek Vaswani**, Dr Ashish Sharma***, Dr J. D. Lakhani**** Junior Residents*, Assistant Professor**, Senior Resident(Cardiology)***, Professor and Head*** Department of General Medicine, SBKS MIRC, Pipariya, Vadodara, Gujarat-391760 Abstract Paclitaxel is a drug with antineoplastic activity which is used in treatment of various cancers like breast, ovarian, lung and other solid tumors including head and neck cancers. The major side effect associated with paclitaxel are bone marrow suppression, alopecia, polyneuropathy and cardiac toxicities. We here, report a case of middle aged male patient diagnosed with oral cancer who developed Acute Coronary Syndrome after starting Paclitaxel infusion. Acute MI can occur due to Paclitaxel administration which is rare but life threatening adverse drug event. Keywords Paclitaxel, NSTEMI, Cardiotoxicity --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 20-03-2021 Date of Acceptance: 04-04-2021 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Paclitaxel is a natural product with antineoplastic activity. 1 It is widely used in treatment of breast, ovarian, lung cancers and other solid tumors including head and neck cancers. 2 Squamous cell carcinoma(SCC) of oral cavity is one the most common malignancies world wide. India and other developing countries have the highest incidence of SCC of oral cavity. 3 Surgery remains the gold standard treatment, but for unresectable disease, curative chemoradiotherapy or palliative radiotherapy has been offered. 5 Paclitaxel has been used in chemotherapy as an induction therapy or secondary treatment for metastatic SCC of head and neck. 6 The major side effects of this drug are bone marrow suppression, alopecia, polyneuropathy and cardiac toxicities. 7 The cardiac toxicities include asymptomatic bradycardia, atrioventricular conduction blocks, atrial arrhythmias, left bundle branch block, ventricular tachycardia, congestive cardiac failure and fatal myocardial infarction. 8 Cardiotoxicity is one of the most serious side effects of chemotherapy, resulting in morbidity and mortality. Cardiac dysfunction due to chemotherapy can be acute, subacute or chronic side effects. It becomes pertinent to learn and discuss about these serious adverse events related to paclitaxel. 9 We hereby aim to report this case of middle aged male patient diagnosed with oral cancer who developed acute coronary syndrome within 60 to 90 minutes after starting paclitaxel infusion. II. Case Report 61 year old male patient who was diagnosed with Squamous Cell Carcinoma of left buccal cavity with spread to Cervical level IA node was scheduled for Induction chemotherapy with Taxane derivative – Paclitaxel injection. Patient was admitted for his first cycle of chemotherapy . On admission he had no complaints of chest pain, palpitations, shortness of breath , and his vitals were within normal limits and all routine investigations (CBC, RFT, LFT, Urine r/m), ECG, Chest X-ray were done and found normal . Intially patient was pre-hydrated with intravenous (IV) Normal Saline(0.9%) 500ml followed by Intravenous Paclitaxel infusion. Patient started complaining of Chest pain which was retrosternal, stabbing type, associated with perspiration, radiating to back after 400 ml of IV Paclitaxel was given. Paclitaxel injection was immediately stopped. ECG was done which was s/o ST depressions in V1-V4 ( Fig 1); and posterior leads (V6,7,8) did not show any ST elevations, cardiac troponin I was Positive and 2D Echo done was normal and rest of the routine blood parameters were within normal limits. Diagnosis of acute coronary syndrome – NSTEMI (Non ST Elevation Myocardial Infarction) was made; loading dose of Inj Heparin (5000 IU, IV), dual antiplatelets (Aspirin, Clopidogrel), statin was given. Chest pain subsided within 30 minutes. Serial ECG monitoring was