Explanation

B. 5-FU (5-fluorouracil) and capecitabine are associated with cardiotoxicity that presents as chest pain, acute coronary syndrome/myocardial infarction, or death. Cardiotoxicity tends to occur during the first cycle of administration with symptoms initiating 12 hours following infusion but can occur any time up to 1 to 2 days after infusion. It is proposed that coronary vasospasm leads to 5-FU–related myocardial ischemia. The coronary vasospasm may have echocardiogram findings that suggest coronary occlusion such as ST-segment elevation, other ST-T abnormalities, and troponin elevation. Only case reports have been published about oxaliplatin echocardiogram changes making options 1 and 4 unlikely. Hypersensitivity to leucovorin is rare. Case reports have described patients commonly presenting with flushing, hives, headaches, body pain, and elevated blood pressure. Chest pain is possible, but a very uncommon presentation.