Abstract
We report the case of a patient with metastatic cardiac tumor who presented with chest
pain and electrocardiographic changes mimicking acute inferior myocardial infarction.
An 84-year-old man who had undergone lung cancer surgery one year earlier was referred
to emergency outpatient visit because of chest pain. His 12-lead electrocardiography
(ECG) showed ST-segment elevation in the inferior leads with reciprocal ST-segment
depression in the precordial and lateral leads, which was initially interpreted as
inferior acute myocardial infarction. By emergency coronary angiography, however,
there was no significant stenosis or occlusion in the right coronary artery or the
left circumflex artery. In echocardiographic examinations after admission, a large
mass was found in the area corresponding to the infero-posterior wall of the left
ventricle, which had been detected only by positron emission tomography with computed
tomography six months earlier. He died one month after admission. Pathological autopsy
revealed a tumor of 8 × 5 cm size in the myocardium of the posterior to inferior wall
of the left ventricle, and diagnosed as cardiac metastasis from lung cancer. ECG changes
with ST-segment elevation, in particular persistent ST-elevation in the absence of
Q waves, can be a sign for tumor invasion of the heart.
Learning objective
It is necessary to consider the possibility of myocardial metastasis when a patient
with malignancy presents with acute myocardial infarction-like electrocardiography
findings. Besides, in this case, positron emission tomography with computed tomography
(PET-CT) had detected an abnormal accumulation in the left ventricle earlier than
when the tumor was pointed out by echocardiography. Multimodality imaging including
PET-CT could help physicians to make the early and accurate diagnosis of metastatic
cardiac tumor.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiology CasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cardiac metastases.J Clin Pathol. 2007; 60: 27-34
- Myocardial metastasis from primary lung cancer: myocardial infarction-like ECG changes and pathologic findings.Jpn J Med. 1991; 30: 213-218
- Cardiac metastasis of lung cancer. A study of metastatic pathways and clinical manifestations.Cancer. 1992; 70: 437-442
- Electrocardiographic markers of cardiac metastasis.Am Heart J. 1986; 112: 1297-1303
- Acute myocardial infarction due to coronary occlusion caused by a metastatic cardiac tumor arising from squamous cell lung cancer: an evaluation with three-dimensional transthoracic echocardiography.Intern Med. 2022; 61: 345-350
- Metastatic cardiac tumor manifested by persistent ST-segment elevation with coexisting reciprocal changes on electrocardiography.Int Heart J. 2014; 55: 466-468
- Electrocardiographic changes in right ventricular metastatic cardiac tumor mimicking acute ST elevation myocardial infarction: a case of misdiagnosis.Turk J Emerg Med. 2019; 19: 33-35
- Electrocardiographic characteristics of metastatic cardiac tumors presenting with ST-segment elevation.J Electrocardiol. 2020; 59: 93-99
- Detection of cardiac metastasis by positron-emission tomography-computed tomography.Circulation. 2005; 112: e61-e62
- Cardiac metastatic melanoma investigated by magnetic resonance imaging.Magn Reson Imaging. 1998; 16: 91-95
Article info
Publication history
Published online: May 20, 2022
Accepted:
April 17,
2022
Received in revised form:
March 31,
2022
Received:
February 17,
2022
Identification
Copyright
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. All rights reserved.
