Squamous Cell Carcinoma Metastatic to the Heart Mimicking ST-Elevation Myocardial Infarction

Chen, Jason; Craft, Colin; Panakos, Andrew; Marhefka, Md

doi:10.29046/tmf.017.1.003

Cited by 4 publications

(8 citation statements)

References 9 publications

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“…Myocardial involvement due to metastasis may provoke ST-segment elevation mimicking AMI ( 3 , 4 ), and the metastasis may occlude the coronary artery via invasion or direct compression, necessitating emergency PCI, as in the present patient ( 2 , 5 - 7 ). Imaging studies, especially 3D TTE, were useful for obtaining information about the extent, size, and relationship of the metastatic tumor to the coronary artery.…”

Section: Discussionmentioning

confidence: 84%

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Acute Myocardial Infarction Due to Coronary Occlusion Caused by a Metastatic Cardiac Tumor Arising from Squamous Cell Lung Cancer: An Evaluation with Three-dimensional Transthoracic Echocardiography

et al. 2022

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A 60-year-old man developed acute myocardial infarction from the total occlusion of the right coronary artery via metastatic squamous lung cancer and was treated with percutaneous coronary intervention (PCI). Computed tomography and transthoracic echocardiography (TTE) revealed a metastatic tumor, and threedimensional TTE was useful for determining the size and location of the tumor in relation to the coronary artery. Six months after PCI, the patient died, and an autopsy confirmed extensive metastasis to the heart and nearby vessels as detected by three-dimensional TTE. Although rare, lung cancer metastasis to the heart may directly occlude the coronary artery.

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Section: Discussionmentioning

confidence: 84%

“…Metastasis to the heart may produce diverse symptoms and signs, and of these, ST segment elevation on electrocardiography (ECG) requires an emergency diagnosis to determine the presence of acute myocardial infarction (AMI), which may require percutaneous coronary intervention (PCI) (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Acute Myocardial Infarction Due to Coronary Occlusion Caused by a Metastatic Cardiac Tumor Arising from Squamous Cell Lung Cancer: An Evaluation with Three-dimensional Transthoracic Echocardiography

et al. 2022

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“…Nevertheless, especially in young adults, the differential diagnosis for STE might be taken into account, including myocarditis, aortic dissection, pulmonary embolism, stress cardiomyopathy, pericarditis, hypercalcemia, early repolarization, intracranial hemorrhage, and rarely, neoplastic invasion of the heart. 1,2,9) Depending on literature, it is estimated that the incidence of these patients with suspected STEMI and other causes of myocardial injury fluctuates around 3%-15%. 2,10) Tumor infiltration is a very rare cause of STE and is most commonly associated with the increased predisposition to thrombosis in a malignant host or metastatic involvement into the pericardium or endocardium.…”

Section: Discussionmentioning

confidence: 99%

“…2,10) Tumor infiltration is a very rare cause of STE and is most commonly associated with the increased predisposition to thrombosis in a malignant host or metastatic involvement into the pericardium or endocardium. 9,11,12) Conversely, the literature states that significant ST-T changes might be present in 77.7% of the patients with myocardial infiltration at echocardiography. 13) It has been reported that in cancer patients, localized STE was the most specific electrocardiographic sign of myocardial infiltration.…”

Section: Discussionmentioning

confidence: 99%

“…Others are breast cancer, esophageal cancer, squamous cell carcinoma of the mouth, melanomas, and lymphomas. 9,[22][23][24][25] Apart from primary cardiac tumors, there are very few case reports of direct neoplastic infiltration into cardiac structures and coronary arteries, which are not associated with metastases. The most common are lung cancer and leukemias.…”

Section: Discussionmentioning

confidence: 99%

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ST Segment Elevation in a Young Woman with Metaplastic Breast Carcinoma

2023

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The 12-lead electrocardiogram (ECG) remains a key tool to diagnose ST elevation myocardial infarction (STEMI). However, a variety of other conditions aside from obstructive coronary disease, including hyperkalemia, myocarditis, pericarditis, and Takotsubo and Brugada syndrome, may also cause ST segment elevation, with an incidence rate of 3%-15% and mean age of 45 ± 14 years. A combination of a detailed past medical history, thorough physical examination, and additional imaging tests may allow physicians to make the correct diagnosis.In this report, we present a case of a 39-year-old woman with metaplastic breast cancer in the process of combined oncological treatment admitted to the emergency department because of general body weakness, chest pain, and accompanying hypotonia with an initial diagnosis of acute coronary syndrome.The ECG at presentation showed ST segment elevation, but owing to the observed neoplastic cachexia and frailty, she was medically managed and the diagnostics were extended to include transthoracic echocardiogram and computed tomography scan. The patient was found to have an external mass that infiltrated into the thoracic wall, pericardium, right ventricle, interventricular septum, and coronary arteries.In cancer patients with chest pain and ST segment elevation, STEMI should not be the only diagnosis taken into account. In our report, using a combination of available cardiac imaging methods, we were able to evaluate the stage of the lesion and coronary involvement.

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An unusual cause of anterior wall ST-elevation myocardial infarction: a case report

Dindane,

Golgor,

Linke

et al. 2024

European Heart Journal - Case Reports

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Background Metastatic tumors, notably lung cancer, can cause conditions resembling acute myocardial infarctions (AMI), contributing to the minor percentage of AMIs unrelated to coronary atherosclerosis. These instances necessitate specialized diagnostic and therapeutic approaches due to the distinct underlying pathology. Case Presentation We report a case of a 65-year-old male with metastatic lung cancer presenting with prolonged angina pectoris. Elevated troponin and creatine kinase levels led to emergency catheterization, revealing a total occlusion of the distal Left Coronary Artery (LCA) attributed to tumor infiltration. Intervention attempts were unsuccessful, and given the palliative context, other revascularization strategies were not pursued. Two-dimensional Transthoracic Echocardiogram (TTE) depicted tumor invasion at the heart’s apex, confirming the diagnosis. The patient passed away shortly after receiving palliative radiation therapy. Summary This case underscores the challenges in diagnosing and managing myocardial infiltrations from metastatic tumors mimicking AMI. It accentuates the importance of imaging studies for accurate diagnosis and the critical evaluation of intervention strategies, highlighting the need for focused palliative care in such complex scenarios.

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Squamous Cell Carcinoma Metastatic to the Heart Mimicking ST-Elevation Myocardial Infarction

Cited by 4 publications

References 9 publications

Acute Myocardial Infarction Due to Coronary Occlusion Caused by a Metastatic Cardiac Tumor Arising from Squamous Cell Lung Cancer: An Evaluation with Three-dimensional Transthoracic Echocardiography

Acute Myocardial Infarction Due to Coronary Occlusion Caused by a Metastatic Cardiac Tumor Arising from Squamous Cell Lung Cancer: An Evaluation with Three-dimensional Transthoracic Echocardiography

ST Segment Elevation in a Young Woman with Metaplastic Breast Carcinoma

An unusual cause of anterior wall ST-elevation myocardial infarction: a case report

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