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伪装成ST段抬高型心肌梗死的心脏肿瘤:一例报告及文献综述

Cardiac Tumor Masquerading as ST Elevation Myocardial Infarction: A Case Report and Literature Review.

作者信息

Xiang Kang, Bhave Prashant D, Whalen S Patrick, Singleton Matthew J

机构信息

Department of Internal Medicine, Wake Forest School of Medicine, USA.

出版信息

J Clin Cases Rep. 2021 Apr;4(2):39-42. Epub 2020 Feb 8.

Abstract

Cardiac tumors are rare, with primary tumors much rarer than secondary. They can present with a variety of symptoms, including cardiogenic shock, arrhythmias, tamponade, and systemic embolism. There have been cases reported of patients having cardiac tumors presenting with ST elevations. While the exact pathophysiological mechanism for ST changes in patient with tumors is not known, proposed theories include tumor emboli to coronary artery, external compression of coronary arteries, stretching of cardiac muscle fibers, inflammatory reactions, and electrolyte transfer from necrotic tumor tissue to adjacent myocardium. We present a case in which the patient had no prior history of malignancy that are presented with cough, shortness of breath, lower extremity edema, ST elevation on electrocardiogram, and was found to have epithelioid tumor in his left ventricle. This case raises awareness of wide differential for ST changes on electrocardiogram besides myocardial infarction, especially in patients who do not present with classic ischemic symptoms.

摘要

心脏肿瘤较为罕见,原发性肿瘤比继发性肿瘤更为罕见。它们可表现出多种症状,包括心源性休克、心律失常、心脏压塞和全身性栓塞。有报道称,患有心脏肿瘤的患者会出现ST段抬高。虽然肿瘤患者ST段改变的确切病理生理机制尚不清楚,但提出的理论包括肿瘤栓子进入冠状动脉、冠状动脉外部受压、心肌纤维拉伸、炎症反应以及坏死肿瘤组织向邻近心肌的电解质转移。我们报告一例患者,该患者既往无恶性肿瘤病史,出现咳嗽、气短、下肢水肿、心电图ST段抬高,经检查发现左心室有上皮样肿瘤。该病例提高了人们对心电图ST段改变除心肌梗死外的广泛鉴别诊断的认识,特别是对于未表现出典型缺血症状的患者。

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Unusual primary tumors of the heart.心脏罕见原发性肿瘤。
Semin Thorac Cardiovasc Surg. 2000 Apr;12(2):89-100. doi: 10.1053/ct.2000.5080.
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Clinical diagnosis of secondary tumors of the heart and pericardium.
Dis Chest. 1969 Mar;55(3):202-8. doi: 10.1378/chest.55.3.202.

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