Diographic changes indicative of myocardial ischemia were revealed. Anti-anginal and anti-thrombotic treatment was introduced. Cardiac enzymes had been not elevated and echocardiographic findings showed no wall motion abnormalities. Twenty 4 hours right after the episode the elctrocardiographic adjustments insisted and chemotherapy was decided to be continued, excluding bleomycin, with no symptom recurrence. Discussion: Cardiovascular complications pose a uncommon but prospective fatal adverse effect of BEP chemotherapy and must be very carefully addressed, particularly in patients with additional cardiovascular threat aspects. Physicians coping with bleomycin-based therapies could obtain this understanding helpful for a extra extensive evaluation of chest pain syndromes in those individuals. Hippokratia 2013, 17, 2: 1787-188 Keywords and phrases: BEP chemotherapy, ovarian cancer, cardiotoxicity, myocardial ischemia, chest painCorresponding Author: Anastasios Boutis, 1st Department of Clinical Oncology-Chemotherapy, Theagenio Cancer Hospital, 54007, Thessaloniki, Greece, tel.: +302310898711, +306937040299, fax:+302310845514, e-mail: [email protected] BEP (bleomycin, etoposide, cisplatin) chemotherapeutic regimen represents the typical of care 1st line therapy in non-epithelial ovarian tumours1. Cardiovascular toxicity is really a uncommon adverse effect of bleomycin and could be expressed clinically as hypotension, pericarditis, acute substernal chest discomfort, coronary artery disease, myocardial ischemia, myocardial infarction, cerebral vascular accident and Raynaud’s phenomenon2. Case report A 41-year-old lady with advanced recurrent ovarian cancer (adult granulosa cell tumor, initial stage pT2b pN1 M0, FIGO IIIC, 4 years ahead of) was treated with first line platinum-based chemotherapy. Pre-treatment cardiovascular risk variables incorporated arterial hypertension (properly controlled with angiotensin II receptor blockers) and obesity (BMI: 40.three Kg/m2). Baseline cardiologic evaluation with ECG and echocardiogram just just before initiation of chemotherapy was unremarkable. Throughout the initial cycle of therapy and in the course of the bleomycin infusion, chest discomfort swiftly progressing to extreme precordial pain radiating for the interscapular region emerged. The patient was tachypnoic, in moderate distress. The infusion was stopped and also the electrocardiogram (ECG) revealed sinus tachycardia (120 bpm), ST segment depressions (two mm) in leads I, II, aVL, V4-V6 and T wave inversions in leads I, II, aVL, V4-V6 (Figure 1A,B).Anti-anginal remedy with glyceryl trinitrate (5 mg qd) and diltiazem (60 mg tid) at the same time as acetylsalicylic acid (one hundred mg qd) and low-molecular weight heparin (bemiparin three,500 IU qd) have been initiated.4-Chloro-2-butenoic acid web Symptoms were relieved in about 20 minutes.201611-92-9 site Cardiac enzymes were not elevated in two serial measurements at 6-hour intervals.PMID:24140575 Echocardiogram revealed no hypokinetic or akinetic myocardial regions. Left ventricular function was regular and no pericardial effusion or other abnormalities were identified. Twenty-four hours immediately after the episode, T wave inversions insisted in leads I, aVL, V4-V6 and flattened T waves appeared in leads II and aVF (Figure 1C). Bleomycin was discontinued and only etoposide-cisplatin chemotherapy was decided to be continued, without any symptom recurrence. Discussion Major cardiovascular toxicity (cerebral ischemic infarction, peripheral arterial thromboembolism, myocardial infarction) of bleomycin appears to become reduce than 1 3. An acute chest pain syndrome, self-limitin.