Zhou Jiawei, Zhan Chengchuang, Zhou Jing, Wei Chao, Zou Cao
Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Echocardiography, The First Affiliated Hospital of Soochow University, Suzhou, China.
Front Cardiovasc Med. 2023 Feb 8;10:1001527. doi: 10.3389/fcvm.2023.1001527. eCollection 2023.
Patients with secondary cardiac cancer occasionally show ST segment elevation that mimics acute coronary syndrome despite the absence of coronary artery occlusion. We herein describe a rare case of secondary cardiac cancer that presented with ST-segment elevation. An 82-year-old Chinese man was admitted to the hospital with chest discomfort. Electrocardiography (ECG) showed ST segment elevation in the precordial leads and low-voltage QRS complexes in limb leads without the development of waves. Unexpectedly, emergency coronary angiography showed no significant stenosis of the coronary arteries. However, fortunately, transthoracic echocardiography (TTE) revealed massive pericardial effusion and a mass at the apex of the ventricular myocardium. Coincidentally, contrast-enhanced chest computed tomography showed primary lung cancer in the left lower lobe, pericardial effusion, and myocardial metastasis at the ventricular apex. The pericardiac fluid contained blood with significantly increased CEA levels and exfoliated tumor cells. The lung histopathological report suggested squamous cell carcinoma. Two months later, the patient died. These findings suggested that the persistent ST-segment without the development of Q waves was associated with ventricular invasion by primary lung cancer and may indicate a poor prognosis. In conclusion, physicians should be aware of persistent ST-segment elevation mimicking myocardial infarction due to cardiac metastasis with a poor prognosis.
继发性心脏癌患者偶尔会出现ST段抬高，尽管没有冠状动脉闭塞，但却酷似急性冠状动脉综合征。我们在此描述一例罕见的表现为ST段抬高的继发性心脏癌病例。一名82岁的中国男性因胸部不适入院。心电图（ECG）显示胸前导联ST段抬高，肢体导联QRS波群低电压，未出现波。出乎意料的是，急诊冠状动脉造影显示冠状动脉无明显狭窄。然而，幸运的是，经胸超声心动图（TTE）显示大量心包积液和心室心肌心尖部有肿块。巧合的是，胸部增强计算机断层扫描显示左肺下叶原发性肺癌、心包积液和心室心尖部心肌转移。心包积液中含有血液，癌胚抗原（CEA）水平显著升高，并有脱落的肿瘤细胞。肺部组织病理学报告提示为鳞状细胞癌。两个月后，患者死亡。这些发现表明，持续的ST段抬高且未出现Q波与原发性肺癌侵犯心室有关，可能预示预后不良。总之，医生应警惕因心脏转移导致的酷似心肌梗死的持续性ST段抬高，其预后较差。
