In seven patients with different types of neoplasm, secondary myocardial infiltration was diagnosed in vivo by two-dimensional echocardiography and confirmed by direct inspection. In all patients, clinical and electrocardiographic findings were suggestive but nonspecific for myocardial involvement. Two patients had cardiac tamponade and three had pericardial effusion. In three patients, the echocardiographic diagnosis made it possible to plan specific therapy. Clinical, electrocardiographic and echocardiographic aspects are discussed. A two-dimensional echocardiographic examination should be performed in all patients when cardiac metastatic involvement is suspected from clinical electrocardiographic findings, because the in vivo diagnosis of such a condition may have important therapeutic implications for such patients.

Two cases of 5-fluorouracil cardiotoxicity, resulting in one patient in myocardial infarction, are described. A review of the literature confirms that cardiotoxicity is a rare but genuine complication of 5-fluorouracil treatment; the cardiotoxic effect seems to range from mild angina without persistent electrocardiographic changes to severe myocardial infarction. No factors predictive of this complication were identified. The authors therefore feel it is advisable to stop 5-fluorouracil treatment when precordial pain occurs, even if the ECG (after angina) is normal, since angina can in some cases result in myocardial infarction.

Systolic time intervals (PEP/LVET ratio) were used for detection of acute variations in myocardial contractility after a single dose of 30, 60, or 75 mg of doxorubicin/m2. This drug induces an acute impairment of left ventricular function (increase in the PEP/LVET ratio) detectable 1 h after doxorubicin injection. The phenomenon appears to be dose-related, with a threshold dose of 30-40 mg/m2. The decrease in myocardial contractility is fully reversible within 24 h, at least after the first dose. This kind of evaluation appears applicable to phase I studies of new anthracycline derivatives.

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