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A case of malignant lymphoma simulating acute myocardial infarction
Y Nishikawa1, M Akaishi, S Handa
1Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Insights
Malignant lymphoma can mimic heart attack symptoms like ST elevation and atrioventricular block. Autopsy revealed lymphoma cells invading the myocardium, not coronary artery disease, highlighting the need for myocardial biopsy in specific cases.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Malignant lymphoma can present with cardiac manifestations.
- Cardiac involvement in lymphoma may mimic acute myocardial infarction.
Observation:
- A patient with malignant lymphoma experienced sudden collapse with electrocardiogram findings of ST segment elevation and complete atrioventricular block.
- Cardiac cineangiography showed left ventricular asynergy without coronary artery obstruction.
Findings:
- Autopsy revealed diffuse myocardial invasion by lymphoma cells.
- Preserved left ventricular wall motion despite massive invasion, with no true necrosis.
- Discrepancy between coronary anatomy and observed wall motion abnormalities.
Implications:
- Myocardial biopsy is crucial for diagnosing cardiac lymphoma when clinical presentation and coronary angiography are discordant.
- Early recognition of cardiac lymphoma can guide appropriate management and improve patient outcomes.
- This case underscores the importance of considering non-ischemic etiologies for acute cardiac events.
Abstract:
A patient with malignant lymphoma suddenly collapsed, and ST segment elevation with complete atrioventricular block was observed on his electrocardiogram during an episode resembling acute myocardial infarction. Cardiac cineangiography revealed posterobasal asynergy of the left ventricle with no significant obstruction in the coronary arterial tree. Autopsy revealed diffuse invasion of the myocardium by lymphoma cells. Left ventricular wall motion was preserved even in the area of massive invasion; there was no true necrosis. Myocardial biopsy may be indicated in patients in whom there is a discrepancy between coronary pathoanatomy and wall motion abnormalities.