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Cardiac Metastasis Mimicking Lateral STEMI in Small-Cell Lung Cancer
Onur Umut Erdoğdu1, Gülsüm Meral Yılmaz Öztekin1
1Department of Cardiology, Antalya Education and Research Hospital, Muratpaşa, Antalya, Türkiye.
Background:
ST-segment elevation in patients with cancer may reflect malignant myocardial-pericardial infiltration rather than acute coronary occlusion.
Case Summary:
A 68-year-old man with active small-cell lung carcinoma receiving chemotherapy presented with acute stabbing chest pain. Electrocardiography showed ST-segment elevation in leads I, aVL, and V2 with inferior reciprocal depression. Transthoracic echocardiography demonstrated anterolateral hypokinesia, focal myocardial discontinuity, and adjacent pericardial effusion. Emergent coronary angiography revealed nonobstructive coronary arteries, and initial high-sensitivity troponin values were nondynamic. Review of recent fluorodeoxyglucose positron emission tomography/computed tomography demonstrated intense hypermetabolic pericardial and adjacent myocardial involvement. One-month follow-up electrocardiography showed persistent ST-segment elevation without Q-wave evolution, with persistently mildly elevated but nondynamic troponin values.
Discussion:
Multimodality correlation favored malignant myocardial-pericardial infiltration over acute coronary occlusion or isolated myocarditis.
Take-Home Message:
Cardiac metastasis is an important ST-segment elevation myocardial infarction mimic in oncology patients.
