Leukemic Ischemia: A Case of Myocardial Infarction Secondary to Leukemic Cardiac Involvement

Abstract

We report a case of a 39-year-old male who presented to the emergency department with acute chest pain while being in remission from T-cell acute lymphoblastic leukemia (T-ALL). Cardiac markers were elevated and EKG revealed ischemic changes compatible with acute myocardial ischemia. Coronary computed tomography angiography (CCTA) showed calcium-free coronary arteries and soft tissue myocardial infiltration suggestive of cardiac leukemia. A bone marrow biopsy confirmed recurrence of T-ALL, and patient was successfully treated with chemotherapy. We discuss the prospective diagnosis of myopericardial leukemic involvement and the role of CCTA in diagnosis and perform a literature review.

Leukemic Infiltration of Myocardium Presenting as Cardiac Arrest

“…Clinically significant cardiovascular disease is a rare but known comorbidity in acute leukemia. Post-mortem studies have identified cardiac involvement in 8.7% to 37% of patients with leukemia and lymphoma ( 2 ). Cardiovascular complications include ischemic heart disease, congestive heart failure, myocarditis, pericarditis, pericardial effusions, cardiac tamponade, and conduction abnormalities.…”

“…Cardiovascular complications include ischemic heart disease, congestive heart failure, myocarditis, pericarditis, pericardial effusions, cardiac tamponade, and conduction abnormalities. Pathophysiologic mechanisms proposed for acute myocardial infarction include leukemic thrombi in coronary vessels, coronary emboli due to an underlying hypercoagulable state, and microvascular obstruction from leukemic invasion ( 2 , 3 ). Patients also have a higher risk of heart failure, likely mediated by direct myocardial infiltration by malignant cells and high levels of proinflammatory cytokine release ( 4 ).…”

New perspectives on treatment strategies for patient with acute myeloid leukemia and complex karyotype abnormalities after percutaneous coronary intervention

“…[28] High coagulation state could be induced by certain solid tumor particularly in some adenocarcinoma, and it is reported that the incidence of AML shows a correlation with hyperhomocysteinemia, and noted that the level of homocysteine would enhance the production of thrombus. [29] In summary, the therapeutic experience for cancer combined with thrombus is lacked and there are few similar reports.…”

Cardiac Infiltration as the First Manifestation of Acute Lymphoblastic Leukemia: A Systematic Review

“…However, 20% (6/30) of patients presented severe chest pain (31)(32)(33)(34) or silent (asymptomatic) myocardium ischemia (35,36) as the first manifestation of acute leukemia relapse, in which one patient (32) manifested an abnormal soft tissue in the left atrioventricular groove with a 50% stenosis in the left circumflex artery by CCTA; one patient (35) showed heavy leukemic infiltration in three major coronary artery branches at autopsy (microscopic); and one patient (36) showed leukemic infiltration with thrombotic occlusion of the vessel lumen at autopsy (microscopic). These results indicated that the AMI-like clinical manifestations (32,35,36) were possibly a result of coronary artery leukemic infiltration or leukemic thrombus.…”

“…As a result, these patients usually missed the best treatment timeline due to the misdiagnosis or delayed diagnosis. Here, 30 scarce cases presented cardiac tamponade (7)(8)(9)(10)(11)(12)(13)(14), cardiac mass (15)(16)(17)(18)(19)(20)(21)(22), myocardium hypertrophy (23)(24)(25)(26)(27)(28)(29)(30), or acute myocardial infarction (AMI) (31)(32)(33)(34)(35)(36) as the first sign of ALL were carefully reviewed, and we provided recommendations of management procedures for the diagnosis and treatment in these atypical ALL patients.…”