Metastatic Cardiac Tumor Presenting as an Anteroseptal ST-Segment Elevation Myocardial Infarction in a Young Male

Abstract

In the appropriate clinical context, ST-segment elevation on electrocardiogram (ECG) necessitates prompt evaluation for coronary artery occlusion requiring reperfusion with percutaneous coronary intervention. Conversely, the etiology of ST-segment elevation may be representative of an alternative diagnosis other than myocardial infarction. We report the case of a patient with a history of primary bone sarcoma who presented for further evaluation of a large pericardial effusion identified on an outpatient echocardiogram and was found to have ST-segment elevation on ECG in the absence of any cardiopulmonary symptoms. The ECG abnormalities were attributed to a likely persistent current of injury resulting from a mass in the interventricular septum, likely representative of a metastatic lesion of his known malignancy. This case highlights the importance of maintaining a broad differential for ST-segment elevation, particularly in patients without symptoms of angina and those with a history of aggressive or relapsing cancer to minimize the morbidity and mortality of invasive procedures.

Unusual echocardiographic finding as cause of acute coronary syndrome with ST- segment elevation

“…To our knowledge there are few case reports in literature describing cardiac metastases from vulvar carcinoma to the heart [4][5][6]. Several case reports have been published with ST-segment changes in context of cardiac tumors [9,10], though the precise pathophysiological mechanism behind the ECG changes continues to be debated [2].…”

Cardiac Metastatic Tumors

“…After numerous consultations and discussions with the patient and his family, the patient decided not to pursue further cardiac diagnostics and was discharged to hospice, where he died shortly thereafter. 33 Doyle and colleagues presented a case report of a 28year-old man diagnosed with high-grade osteosarcoma of the left proximal humerus and disseminated metastases to the lungs. The patient developed tachycardia with a heart rate of 140/min and dyspnea in the course of the disease.…”

“…The patient was cardiologically asymptomatic, although an ECG showed ST-segment elevation. After numerous consultations and discussions with the patient and his family, the patient decided not to pursue further cardiac diagnostics and was discharged to hospice, where he died shortly thereafter 33…”