Abe S, Watanabe N, Ogura S, Kunikane H, Isobe H, Yamaguchi E, Munakata M, Kawakami Y
First Department of Medicine, School of Medicine, Hokkaido University, Sapporo, Japan.
Jpn J Med. 1991 May-Jun;30(3):213-8. doi: 10.2169/internalmedicine1962.30.213.
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 (11.9%). ECG of patients with myocardial metastasis revealed ST-T wave changes and various types of arrhythmia. ST-T wave changes 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. Two very rare cases with myocardial metastasis showing progressive ST segment elevation with a QS pattern 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 ECG changes is of primary importance for the antemortem diagnosis.
肿瘤性疾病的心肌转移在临床上常不明显，且很难诊断。在151例连续的肺癌患者尸检中，67例（44.4%）发现有心脏转移。仅8例（11.9%）发现有心肌转移。心肌转移患者的心电图显示ST-T波改变和各种类型的心律失常。4例心肌转移患者及6例无心肌转移（仅心包转移）患者观察到ST-T波改变。ST-T波改变并非心肌转移的特异性表现。现报告2例非常罕见的心肌转移病例，表现为ST段进行性抬高伴QS波型。在无提示心肌损伤的心脏症状的临床稳定肺癌患者中出现ST段抬高伴QS波型提示心肌转移的可能性。心肌转移常难以捉摸，因此仔细观察心电图变化对生前诊断至关重要。
