Case report: Persistent ST-segment elevation due to cardiac metastasis from lung cancer
Jiawei Zhou1,2, Chengchuang Zhan1, Jing Zhou1
1Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Frontiers in Cardiovascular Medicine
|February 27, 2023
Summary
Secondary cardiac cancer can cause ST-segment elevation mimicking heart attacks, even without blocked arteries. This rare presentation, linked to ventricular invasion, indicates a poor prognosis for cancer patients.
Area of Science:
- Cardiology
- Oncology
Background:
- Secondary cardiac cancer is an uncommon condition.
- ST-segment elevation on electrocardiography (ECG) typically suggests acute coronary syndrome (ACS).
Observation:
- A rare case of an 82-year-old man with chest discomfort presented with ST-segment elevation and low-voltage QRS complexes on ECG.
- Coronary angiography revealed no significant coronary artery stenosis.
- Transthoracic echocardiography (TTE) and chest computed tomography (CT) identified pericardial effusion, a ventricular myocardial mass, and primary lung cancer with metastasis.
Findings:
- The patient's pericardial fluid showed elevated CEA levels and exfoliated tumor cells, consistent with squamous cell carcinoma metastasis.
- Persistent ST-segment elevation without Q waves was associated with ventricular invasion by lung cancer.
- This presentation was linked to a poor prognosis, with the patient dying two months later.
Implications:
- Physicians should consider cardiac metastasis in patients presenting with ST-segment elevation mimicking myocardial infarction, especially in the absence of coronary artery occlusion.
- This ECG finding in the context of cancer may signify advanced disease and a poor prognosis.
- Awareness of this rare presentation is crucial for appropriate diagnosis and patient management.
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