Myocardial Metastasis from Primary Lung Cancer: Myocardial Infarction-like ECG Changes and Pathologic Findings.

Abstract

Myocardial metastasis from neoplastic disease is often clinically unapparent, and very difficult to diagnose. Of 151 consecutive autopsies of lung cancer patients, cardiac metastases were found in 67 patients (44.4%). Myocardial metastasis was found in only 8 patients (ll.9%). ECGof patients with myocardial metastasis revealed ST-Twavechanges and various types of arrhythmia. ST-Twavechanges were observed in 4 with myocardial metastasis, and in 6 without myocardial metastasis (pericardial metastasis alone). ST-T wave changes is not a specific finding of myocardial metastasis. Twovery rare cases with myocardial metastasis showing progressive ST segment elevation with a QSpattern are presented. The appearance of ST segment elevation with a QS pattern in clinically stable lung cancer patients without cardiac symptoms suggestive of myocardial injury indicates the possibility of myocardial metastasis. Myocardial metastasis is often elusive, thus careful observation of ECGchanges is of primary importance for the antemortem diagnosis.

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

“…The relevance of ECG changes as an indicator of cardiac metastases is not well established. ST-T wave changes are the most common abnormality seen in patients with myocardial metastases [6]. ECG findings similar to myocardial infarction can be observed in some patients [6][7][8].…”

“…ST-T wave changes are the most common abnormality seen in patients with myocardial metastases [6]. ECG findings similar to myocardial infarction can be observed in some patients [6][7][8]. Echocardiography could be a valuable tool to define the diagnosis in patients with lung cancer and ST-T wave alterations.…”

Electrocardiographic manifestations of heart metastasis from a primary lung cancer

“…Thus, most of them are found at autopsy [1,2,8]. The signs and symptoms are not specific and consist in chest pain, dyspnoea, tachycardia, arrhythmias, and electrocardiographic changes [3,4,5].…”

A case of myocardial involvement in lung cancer that mimics ST segment elevation in myocardial infarction

“…The pericardium is the most common site of cardiac involvement in lung cancer, while myocardial involvement is rare [2]. Neoplasms that involve the myocardium can cause various electrocardiographic abnormalities; however, it is unusual to observe ST segment elevation in more than two contiguous leads mimicking myocardial infarction (MI) without coronary artery occlusion [3]. Here, we report a case of a 62-year-old male with lung cancer invasion of the myocardium that presented with chest pain and electrocardiography (ECG) findings mimicking acute ST segment elevation MI.…”

“…The most frequently involved site within the heart is the pericardium and the most frequent mode of metastasis is via the lymphatic pathway, followed by hematogenous spread. Myocardial involvement by direct lung cancer invasion is unusual [2] and is often clinically silent, although it can cause malignant pericardial effusion with or without symptoms of pericarditis, arrhythmias, heart failure, and rarely acute MI [3,4,5]. Acute MI might be caused by tumor embolization on the coronary arteries or direct tumor compression of the coronary arteries.…”