Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Department of Medicine, Division of Cardiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
J Electrocardiol. 2023 May-Jun;78:29-33. doi: 10.1016/j.jelectrocard.2023.01.012. Epub 2023 Jan 30.
In the right clinical setting, ST segment elevation (STE) on electrocardiogram (ECG) is most concerning for acute injury due to transmural myocardial ischemia. This frequently points to significant epicardial coronary artery disease, mandating emergent cardiac intervention. In rare cases, cardiac metastases may cause transient STE. We present a case of a 28-year-old male patient with metastatic osteosarcoma with STE in three different ECG territories over ten months. Several transient, dynamic patterns of STE were noted: anteroseptal leads concerning for acute injury with reciprocal ST depressions in inferior leads, lateral leads, inferior leads with reciprocal ST depression in lateral leads, followed by STE again in lateral leads. Given the patient's young age, absence of cardiac history or symptoms, personal preference, bleeding risk, and cancer prognosis, cardiac catheterization was never pursued. We present this case to remind providers to include metastatic cancer in the differential diagnosis of STE on ECG, and that these changes can be dynamic.
在适当的临床环境下，心电图（ECG）上的 ST 段抬高（STE）最令人关注的是由于透壁性心肌缺血引起的急性损伤。这通常指向严重的心外膜冠状动脉疾病，需要紧急心脏介入治疗。在极少数情况下，心脏转移瘤可能导致短暂的 STE。我们报告了一例 28 岁男性患者，患有骨肉瘤转移，在十个月内三个不同的心电图导联出现 STE。观察到几种短暂、动态的 STE 模式：前间隔导联提示急性损伤，下壁导联出现对应性 ST 段压低，侧壁导联、下壁导联出现对应性 ST 段压低，随后侧壁导联再次出现 STE。鉴于患者年龄较轻，无心脏病史或症状，个人偏好，出血风险和癌症预后，从未进行过心脏导管检查。我们提出这个病例是为了提醒医生在心电图 STE 的鉴别诊断中包括转移性癌症，并且这些变化可能是动态的。
