Cardiac sarcoma presenting as acute coronary syndrome: a case report

Cardiac masses encompass a wide range of differentials, including primary and secondary malignancies and can present with a variety of symptoms, many of which are non-specific. Among the primary malignant tumours, cardiac sarcoma can present with symptoms such as heart failure, chest pain, arrhythmia, pericardial effusion, chest pain, and pulmonary thromboembolism.

We report a case of a patient who presented with acute coronary syndrome (ACS) and coronary angiography (CAG) revealed lesions in the left anterior descending artery (LAD) and left circumflex artery (LCX). Percutaneous transluminal coronary angioplasty was performed. The patient again presented with chest pain after 5 months. CAG revealed total in-stent restenosis of LAD and LCX due to compression and invasion of coronary artery by cardiac sarcoma, as evidenced by two-dimensional echocardiography (2D ECHO), cardiac magnetic resonance (CMR) and 18F Fluorodeoxyglucose positron emission tomography scan (PET) scan findings.

Cardiac sarcomas are the most common primary cardiac malignancy, with undifferentiated pleiomorphic sarcoma being a common sub-type. Diagnosing cardiac sarcomas presents significant challenges due to their rarity, non-specific symptoms. It has a variety of presentations, but presenting as ACS is very rare. Only a few case reports of cardiac sarcoma presenting with ACS have been documented, mostly due to tumour embolization. In our case, the patient presented with ACS due to compression and invasion of the LAD and LCX by the tumour.