Metastatic Cancer Masquerading as Acute Coronary Syndrome
Suman Rao1, Zachariah Nealy2, Alisha Khan2
1Department of Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA.
Insights
Heart metastases can mimic heart failure or acute coronary syndrome. Early diagnosis using echocardiography and cardiac MRI is crucial for managing metastatic heart disease.
Area of Science:
- Cardiology
- Oncology
Background:
- Metastatic heart disease can present with symptoms overlapping those of common cardiac emergencies.
- Patients with a history of coronary artery disease may be misdiagnosed.
Observation:
- The patient presented with chest pain, elevated troponin, and EKG changes suggestive of acute coronary syndrome.
- Echocardiography revealed a right ventricular mass and pericardial effusion.
- CT scans identified pulmonary and liver metastases.
Findings:
- The case highlights the diagnostic challenge posed by the insidious presentation of heart metastases.
- Initial presentation mimicked acute coronary syndrome, delaying the diagnosis of metastatic disease.
Implications:
- Medical professionals must consider metastatic heart disease in patients with overlapping symptoms.
- Prompt diagnosis via echocardiography and cardiac MRI is essential for appropriate management.
- Multidisciplinary approaches including surgery may be necessary for effective treatment.
Abstract:
Patients with heart metastases could present insidiously, with symptoms that mimic those of congestive heart failure or acute coronary syndrome. Our patient initially presented with vague lower sternal and abdominal pain and had a past medical history of coronary artery disease. Her first two troponin levels were elevated, and her EKG was significant for ischemic changes. Echocardiography showed a large mass in the right ventricle and the presence of pericardial effusion. CT scan of the thorax, abdomen, and pelvis showed multiple pulmonary nodules as well as liver metastases. Our patient opted not to pursue further imaging such as cardiac MRI or a liver biopsy. It is imperative that medical professionals are aware of the presentational overlap between acute coronary syndrome and metastatic heart disease, in order to ensure proper diagnosis and management of the latter with echocardiography, cardiac MRI, and possibly surgery.
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