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Myocardial metastasis from primary lung cancer: myocardial infarction-like ECG changes and pathologic findings
1First Department of Medicine, School of Medicine, Hokkaido University, Sapporo, Japan.
Insights
Diagnosing myocardial metastasis in lung cancer patients is challenging. Specific ECG changes like ST segment elevation with a QS pattern can indicate this elusive condition, aiding antemortem diagnosis.
Area of Science:
- Oncology
- Cardiology
- Pathology
Background:
- Myocardial metastasis from cancer is often asymptomatic and difficult to detect.
- Cardiac metastases are common in lung cancer patients, but myocardial involvement is less frequent.
- Electrocardiogram (ECG) findings in myocardial metastasis can be non-specific.
Abstract:
Myocardial metastasis from neoplastic disease is often clinically unapparent, and very difficult to diagnose. Of 151 consecutive autopsies of lung cancer patients, cardiac metastases were found in 67 patients (44.4%). Myocardial metastasis was found in only 8 patients (11.9%). ECG of patients with myocardial metastasis revealed ST-T wave changes and various types of arrhythmia. ST-T wave changes were observed in 4 with myocardial metastasis, and in 6 without myocardial metastasis (pericardial metastasis alone). ST-T wave changes is not a specific finding of myocardial metastasis. Two very rare cases with myocardial metastasis showing progressive ST segment elevation with a QS pattern are presented. The appearance of ST segment elevation with a QS pattern in clinically stable lung cancer patients without cardiac symptoms suggestive of myocardial injury indicates the possibility of myocardial metastasis. Myocardial metastasis is often elusive, thus careful observation of ECG changes is of primary importance for the antemortem diagnosis.