[The cardiac toxicity of cancer chemotherapy]. / Cardiotoxicidade da quimioterapia oncológica.

The presence of secondary effects following the administration of chemotherapeutic drugs is an important limitation to cancer therapy. Of these, cardiotoxicity is of crucial importance due to its negative influence on survival. The anthracyclines and cyclophosphamide are the most important cardiotoxic antineoplastic agents currently used. If we agree on a ceiling dosage of chemotherapy we will deprive some patients with a highly functional cardiac reserve of a potential benefit in the control of their cancer. Other patients who are more susceptible to the cardiotoxic effects of anticancer agents will suffer from severe cardiac disfunction following small cumulative doses of anthracyclines. The authors discuss the main cardiotoxic effects of several antineoplastic drugs with special attention given to the anthracycline group. Several diagnostic methods potentially useful in cardiac monitoring are described. Radionuclide angiocardiography is considered the gold-standard in monitoring anthracycline cardiotoxicity. Other invasive methods like endomyocardial biopsy and right heart catheterization can be clinically useful when nuclear angiocardiography is inconclusive. The authors propose an approach to the prevention of anthracycline cardiotoxicity. Other chemotherapeutic agents like cyclophosphamide are associated with the presence of myopericarditis which is sometimes fatal. The cardiotoxic effects of anticancer treatment with 5-fluorouracil, mitoxantrone, carmustine, amsacrine and interferon are less frequent and usually more benign. Finally we discuss bone marrow transplantation and its related cardiotoxicity.

[Pulmonary embolism--mortality risk]. / Embolia pulmonar--risco de mortalidade.

We conducted a retrospective analysis on 311 patients with clinical diagnosis of pulmonary embolism (PE) in a period of 3 years. 163 patients were excluded based on clinical-laboratorial criteria. The remaining 146 patients had a median age of 69 years (range: 30-91 years). 54% of the patients were male. We found dyspnea (94%), abnormal cardiopulmonary observation (89%), risk factors for venous thromboembolism (74%), tachycardia (53%), cyanosis (49%), and neck vein distension (45%) to be the most frequent findings. 64% of the patients had heart failure, 32% had myocardial ischemia, 13% had cancer, and 11% had myocardial infarction. Lactic dehydrogenase (LDH) was higher than two-fold in 54% of the patients. There was severe hypoxemia in 55% of the cases and hypocapnia in 43% of the cases. Creatinine phosphokinase (CPK) was elevated in 16% of the cases. Electrocardiography was suggestive of PE in 37% of the cases. Echocardiography showed right heart dysfunction in 30% of the cases, 92% of the patients were treated with heparin, 37 patients (25%) died, 54% of which during the first 4 days after admittance. Trying to define an index of mortality in PE we evaluated all patients by discriminant analysis coming up with 14 items with good discriminative power. By approximation of their odds-ratios we determined how many points would correspond to each item in the total sum.(ABSTRACT TRUNCATED AT 250 WORDS)