[Electrocardiographic characteristics of a secondary tumorous lesion of the heart]. / Elektrokardiograficheskaia kharakteristika vtorichnogo opukholevogo porazheniia serdtsa.

The main electrocardiographic signs of metastasis and spread of malignant tumors to the heart in 123 patients were studied. The most reliable electrocardiographic criterion of tumor metastasis to the heart are signs of a macrofocal lesion with no dynamics of changes characteristic of ischemic heart disease. Spread of a tumor to the heart and micronodal metastasis are characterized by the appearance of signs of microfocal myocardial lesion on the ECG. Specific carcinomatous pericarditis has all the ECG signs that are typical of pericarditis of any other etiology. Electrical alternation in an oncological patient is a convincing sign of metastatic lesion of the heart.

[Cardiac alternation in pericarditis with effusion]. / Al'ternatsiia serdtsa pri vypotnom perikardite.

Alternation of the heart was revealed in 18 of 74 patients with tumorous pericarditis with effusion (24%). It was found most frequently in patients with a drastically enlarged heart and a large amount of exudate in the pericardial cavity. An electrical, mechanical and mixed character of alternation was encountered in pericarditis with effusion. Electrical alternation was caused by increased mobility of the heart in the fluid, mechanical alternation (pulsus alternans) was caused by diminished contractile function of the myocardium. In certain cases alternation of the heart is a reversible process and may disappear under the effect of treatment including irradiation, chemotherapy and pericardiocentesis.

[Echocardiography in the diagnosis of exudative pericarditis]. / Ekhokardiografiia v diagnostike ekssudativnykh perikarditov.

Echocardiography revealed pericardial effusion in 20 patients with various oncologic diseases. Chest X-ray showed effusion only in 5 patients, electrocardiographic signs of pericarditis were found in 12 patients. Echocardiography is an exact and simple method for the diagnosis of exudative pericarditis.

[Secondary tumors of the heart (based on autopsy materials in the Oncology Research Center of the Academy of Medical Sciences of the USSR over the period of 1960-1977)]. / Vtorichnye opukholi serdtsa (po materialam autopsii v Onkologicheskom nauchnom tsentre AMN SSSR za 1960-1977 gg.).

The autopsy material of the USSR AMS Cancer Research Center for 1960--1977 was studied. Among 3327 patients dying of malignant tumours, secondary tumour involvement of the heart was revealed in 170 (5.1%) cases, in 119 patients the tumour metastasized into the heart, in 51 grew into the pericardium. Most frequently, tumour involvement of the heart occurred in lung cancer, systemic diseases of the hemopoietic tissue, melanoma, and mammary gland carcinoma. Growth of the tumour into the heart, as a rule, was found in systemic diseases and lung cancer. Melanoma, renal carcinoma, and carcinoma of the oral cavity were characterized by small- and large-nodular forms of metastasis. The tumour involvement was most frequently found in the pericardium followed by the myocardium. In outgrowths of the tumour, the outer layer of the pericardium and in small-nodular metastases the visceral layer (epicardium) were affected most frequently. Hemorrhagic pericarditis was frequently observed in tumour alterations of the heart. Metastases and outgrowths into the heart were always associated with progression of the tumour.

[Comparative evaluation of the cardiotoxic effects of antineoplastic antibiotics adriamycin and pharmorubicin]. / Sravnite'lnaia otsenka kardiotoksicheskogo deistviia protivo- opukholevykh antibiotikov adriamitsina i farmorubitsina.

Thirty patients with Grade III breast cancer, a locally common form, were examined to compare the magnitude of the cardiotoxic effects displayed by the antitumor anthracyclic antibiotics adriamycin (15 patients) and pharmorubicin (15 patients). Clinical symptoms of cardiotoxicity developed in 13.3% of the pharmorubicin-treated and in 40% of the adriamycin-treated patients. Among the noninvasive techniques, electrocardiography turned out to be more informative, which enabled the signs of myocardial dystrophy and cardiac arrhythmias to be identified in 20 and 40% on pharmorubicin and adriamycin, respectively. Poly- and echocardiography proved to be less informative than it was shown by the data available in the literature, which is associated with the use of relatively small total doses of anthracycline in our investigations.

[Postradiation pericarditis in lymphogranulomatosis patients]. / Postluchevye perikardity u bol'nykh limfogranulematozom.

Postradiation pericarditis was diagnosed in 11 of 52 patients treated for lymphogranulomatosis with radiation applied to enlarged mediastinal lymph nodes. The risk of postradiation pericarditis is greater in cases of high radiation doses (more than 45 Gy) and in patients with postradiation pneumonitis. Postradiation pericarditis can develop both during the exposure and long after radiation therapy; therefore long-term follow-up is required for these patients.

[Clinical aspects and diagnosis of metastatic pericarditis in cancer patients]. / Klinika i diagnostika metastaticheskogo perikardita u onkologicheskikh bol'nykh.

Metastatic pericarditis was identified in 74 out of 240 cancer patients suffering from secondary tumor lesions in the heart (30.8%). It involved quick accumulation of exudate which led to grave heart failure due to cardiac tamponade development in 39%. Liquid in the heart sac was detected by X-rays in 20, ECG-39, and echocardiography--in 83% of patients. Application of echocardiography provides a means for ascertaining the extent of pericardial involvement and monitoring changes in tumor process occurring in the course of therapy.

[Cardiotoxic effect of cytostatics in patients with breast cancer]. / Kardiotoksicheskoe deistvie tsitostatikov u bol'nykh rakom molochnoi zhelezy.

Clinical and instrumental (ECG, PCG, ultrasonic cardiography and polycardiography) examination of cardiac activity in 98 breast cancer patients treated at the Center after Cooper established the cardiotoxic effect of 5-fluorouracil, vincristine, methotrexate, cyclophosphamide and corticosteroids. 46% of them suffered pain in the region of the heart, tachycardia, extrasystole, atrial flutter and deranged conduction function. Congestive heart failure was observed in 7% only. In 24%, myocardial lesions could be detected by instrumental means only. They were identified on the basis of an increase in terminal diastole and systole volume and mass of the myocardium matched by a decrease in stroke volume, PCG amplitude, % delta S and VCF. Cardiac disorders did not persist and were hardly detectable during medication course intervals or one-two months after treatment.

[An evaluation of the cardioprotective action of the preparation ICRF-187 (Cardioxane) during the treatment of breast cancer with large doses of adriamycin]. / Otsenka kardioprotektivnogo deistviia preparata ICRF-187 (kardioksan) pri lechenii bol'nykh rakom molochnoi zhelezy bol'shimi dozami adriamitsina.

Twenty females with disseminated breast cancer received courses of polychemotherapy with 21-day intervals. The regimen comprised adriamycin (ADM), cyclophosphamide and 5-fluorouracil in the dose 50, 500 mg/m2, respectively. 30 minutes prior to the treatment the patients were given the cardioprotector cardioxan (1000 mg/m2). Cardiological control (ECG, EF according to echo-CG and radionuclide ventriculography, PP/EP M1/M2, T1/T2 according to echo-polycardiography and Doppler cardiography) was performed before the treatment and at ADM total dose 200-300 mg/m2 followed by measurements at each dose increase by 100 mg/m2. The findings showed no evidence of ADM-related cardiac damage up to ADM dose 900-1000 mg/m2 in the case of cardioxan protection, though there was a tendency to M1/M2 increase which needs further studies as it suggests worsening of left ventricular diastolic contractility.