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Three, dynamic variants of ST segment elevations in a patient with osteosarcoma and cardiac metastasis

Margaret Doyle1, Sean Dikdan2, Darius Farzad2

  • 1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.

Journal of Electrocardiology
|February 5, 2023
PubMed

Insights

ST segment elevation (STE) on electrocardiogram (ECG) can indicate acute myocardial injury. This case highlights that cardiac metastases from osteosarcoma can also cause dynamic STE, expanding the differential diagnosis.

Area of Science:

  • Cardiology
  • Oncology

Background:

  • ST segment elevation (STE) on electrocardiogram (ECG) typically suggests acute transmural myocardial ischemia and coronary artery disease.
  • While rare, cardiac metastases can present with STE, necessitating a broader differential diagnosis.

Observation:

  • A 28-year-old male with metastatic osteosarcoma experienced transient, dynamic STE in multiple ECG territories over ten months.
  • Observed patterns included anteroseptal and lateral STE with reciprocal ST depressions, evolving over time.
  • The patient's age, lack of cardiac history, and cancer prognosis precluded cardiac catheterization.

Findings:

  • Metastatic osteosarcoma was identified as the cause of dynamic STE in this patient.
  • The ECG findings mimicked acute ischemic events but were attributed to cardiac metastases.

Implications:

  • This case underscores the importance of considering metastatic cancer in the differential diagnosis of STE on ECG, especially in young patients.
  • Recognizing dynamic STE patterns can aid in diagnosing rare cardiac manifestations of malignancy.
  • Highlights the need for comprehensive evaluation when unusual ECG findings are present in cancer patients.

Keywords:
Cardiac metastasisECGOsteosarcomaSTESTEMI

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