Causes of Persistent ST Elevation in Patients With Lung Cancer: A Case Report

Cardiac metastases are rare in clinical practice. Herein, we describe the case of a 61-year-old male patient who underwent radical left lung cancer surgery > 2 years before the current admission. The postoperative diagnosis was left lung squamous cell carcinoma (stage pT2N1M0/IIB). Post-surgery, he received adjuvant chemotherapy and did not undergo chest radiotherapy. At the current admission, the patient presented with a dull pain in the left side of his chest. Electrocardiography (ECG) revealed ST-segment elevation; repeat troponin and cardiac enzyme levels were negative. Coronary CT showed 55%-77% stenosis in the proximal-mid left anterior descending artery, but no severe occlusive disease in the other major branches. Cardiac ultrasound revealed a 104 × 49 mm hypoechoic mass at the lateral apex without regional wall motion abnormalities or pericardial effusion. Contrast-enhanced chest CT revealed a metastatic tumor in the left anterior mediastinum with invasion of the pericardium and local left ventricular wall. ST-segment elevation on ECG does not always indicate acute myocardial infarction. In patients with advanced cancer, if unexplained persistent ST elevation without pathological Q waves is observed, the possibility of cardiac metastasis should be considered.