Atrial flutter and myocardial infarction-like ECG changes as manifestations of left ventricle involvement from lung carcinoma

Abstract

Lung cancer involvement of the heart is not unusual, but in most cases is silent. Arrhythmia and electrocardiographic findings suggesting an acute myocardial infarction could be the first manifestation of myocardial infiltration by the tumour. Echocardiography could be a valuable tool to define the diagnosis in patients with lung cancer and newly diagnosed arrhythmia or ST-T wave alterations. When echocardiographics findings are not conclusive, magnetic resonance imaging (MRI) allows differentiation between tumour and myocardium.

Electrocardiographic changes in lung cancer. Be careful not to misdiagnose: acute coronary event? meta? inflammation?

“…The most common ECg abnormalities were inverted T waves in iii and aVF (48.6%), inverted T waves in V 2 -V 4 (41.8%) and ST-segment depression in V 4 -V 6 (26.4%) [21]. Because in our case the ECg showed inversion of T waves in ii, iii, aVF, V 3 -V 6 and ST seg- according to available case reports, any new ECg changes in patients with lung cancer, particularly if they suggest aCS without appropriate symptoms, and are not accompanied by elevated troponin levels, can indicate cardiac metastases [10][11][12][13][14][15][16]. in our case, the stage and location of the tumour suggested cardiac metastases, which may occur in up to 18% of cases of squamous cell lung cancer [22].…”

“…The only symptoms of myocardial metastases may be cardiac arrhythmias or ECg patterns indicative of acute vascular toxicities, mainly aCS (inverted T waves, ST-segment depression, or ST elevation in ECg) [14][15][16][17].…”

“…When an oncological patient presents nonspecific changes in ST-T waves, echocardiography can help establish the correct diagnosis [14]. Echocardiography increases diagnostic accuracy in patients with atypical symptoms and allows evaluation of different cardiac causes of chest pain [18].…”

“…However, in selected cases, cardiac magnetic resonance imaging (CMr) is the only method capable of making a definitive diagnosis [14,16]. as a result of CMr, myocardial structure and function are accurately assessed, so it is possible to diagnose cardiotoxicity (ischemia, inflammation, fibrosis), infiltrative cardiomyopathy, Electrocardiographic changes in lung cancer.…”