A Rare Presentation of Cardiac Lipoma as an Acute Coronary Syndrome: A Case Report and Review of Literature.

Cardiac lipomas are rare benign cardiac tumors that are seldom symptomatic. We present a case of a 49-year-old female who presented with one week of substernal chest pain and uncontrolled hypertension. Initial workup showed left ventricular hypertrophy with non-specific intraventricular delay and T wave inversion in leads I and aVL on electrocardiogram (EKG), troponinemia, and elevated brain natriuretic peptide levels. A transthoracic echocardiogram showed mildly reduced left ventricular ejection fraction and severe segmental hypokinesis of the left ventricle. The patient was admitted to the hospital as a case of non-ST elevation myocardial infarction (NSTEMI), and appropriate treatment was commenced. The patient underwent an urgent coronary angiogram that showed no significant epicardial coronary artery disease. Subsequently, a gadolinium-enhanced cardiac MRI (CMR) was performed to rule out underlying structural abnormalities, which demonstrated a well-demarcated cardiac mass involving the left ventricular wall with characteristic features of cardiac lipoma. The patient had a favorable prognosis with conservative management, and she was discharged home in stable condition with a close follow-up for repeat CMR. Although more studies are required, we suggest that cardiac MRI should be considered in patients with NSTEMI and non-revealing coronary angiography to rule out underlying cardiac tumors such as cardiac lipoma.