ST Segment Elevation in a Young Woman with Metaplastic Breast Carcinoma
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Published on: December 5, 2017
Paulina Wieczorkiewicz1, Konrad Szymczyk1, Marzenna Zielinska1
1Department of Interventional Cardiology, Medical University of Lodz.
Insights
ST elevation on ECGs can mimic myocardial infarction but may indicate other serious conditions. This case highlights a rare instance of breast cancer infiltrating the heart, causing ST elevation and chest pain.
Area of Science:
- Cardiology
- Oncology
Background:
- The 12-lead electrocardiogram (ECG) is crucial for diagnosing ST elevation myocardial infarction (STEMI).
- However, ST segment elevation can be caused by various non-obstructive coronary disease conditions, affecting 3%-15% of patients.
- Accurate diagnosis requires integrating medical history, physical examination, and advanced imaging.
Observation:
- A 39-year-old woman undergoing cancer treatment presented with chest pain and weakness, initially suspected as acute coronary syndrome.
- Her ECG showed ST segment elevation, but her cachectic state prompted further investigation beyond STEMI.
- Imaging revealed a tumor infiltrating the chest wall, pericardium, and heart structures, including coronary arteries.
Findings:
- The patient's ST elevation was caused by neoplastic infiltration, not obstructive coronary disease.
- Cardiac imaging successfully identified the extent of tumor involvement in cardiac structures and coronary arteries.
- This case underscores the importance of considering non-coronary causes of ST elevation in cancer patients.
Implications:
- In cancer patients presenting with chest pain and ST elevation, STEMI should not be the sole consideration.
- Comprehensive diagnostic approaches, including cardiac imaging, are vital for accurate diagnosis and management.
- This case expands the differential diagnosis for ST elevation in the context of active oncological treatment.
Abstract:
The 12-lead electrocardiogram (ECG) remains a key tool to diagnose ST elevation myocardial infarction (STEMI). However, a variety of other conditions aside from obstructive coronary disease, including hyperkalemia, myocarditis, pericarditis, and Takotsubo and Brugada syndrome, may also cause ST segment elevation, with an incidence rate of 3%-15% and mean age of 45 ± 14 years. A combination of a detailed past medical history, thorough physical examination, and additional imaging tests may allow physicians to make the correct diagnosis.In this report, we present a case of a 39-year-old woman with metaplastic breast cancer in the process of combined oncological treatment admitted to the emergency department because of general body weakness, chest pain, and accompanying hypotonia with an initial diagnosis of acute coronary syndrome.The ECG at presentation showed ST segment elevation, but owing to the observed neoplastic cachexia and frailty, she was medically managed and the diagnostics were extended to include transthoracic echocardiogram and computed tomography scan. The patient was found to have an external mass that infiltrated into the thoracic wall, pericardium, right ventricle, interventricular septum, and coronary arteries.In cancer patients with chest pain and ST segment elevation, STEMI should not be the only diagnosis taken into account. In our report, using a combination of available cardiac imaging methods, we were able to evaluate the stage of the lesion and coronary involvement.
