Ndukwe Marilyn, Zheng Jimmy, Collins Briana, Trinh Katherine V, Akinrimisi Olumuyiwa, Kabir Ryan A, Yeung Alan, Pizula Jena R
Department of Medicine, Stanford University, Stanford, California, USA.
Department of Medicine, Stanford University, Stanford, California, USA.
JACC Case Rep. 2025 May 21;30(11):103322. doi: 10.1016/j.jaccas.2025.103322. Epub 2025 Apr 9.
Cardiac metastasis of malignant tumors is rare but can mimic myocardial infarction (MI). We review a case of myopericardial metastasis presenting as ST-segment elevation MI (STEMI) and the clinical characteristics of cardiac injury from malignant metastasis.
A 78-year-old woman with a history of breast cancer and recently diagnosed pulmonary spindle cell carcinoma presented with progressive tongue pain related to metastasis. Her electrocardiogram showed ST-segment elevations in leads I, aVL, and V with reciprocal changes in leads III and aVF on a background of atrial fibrillation. She had no chest pain, but elevated lactate (6.6 mmol/L) and high-sensitivity troponin T (45 ng/L) raised concern for STEMI. Coronary angiography revealed no obstructive coronary disease. Echocardiogram found an intramyocardial mass extending into the pericardium. The patient was transitioned to comfort care because of her poor oncologic prognosis.
TAKE-HOME MESSAGES: In advanced cancer, myocardial metastasis should be considered a cause of persistent ST-segment elevations. Echocardiography should be prioritized to identify structural abnormalities, such as malignant myocardial infiltration, whereas coronary angiography remains essential to rule out acute MI when clinically indicated.
恶性肿瘤的心脏转移罕见，但可酷似心肌梗死（MI）。我们回顾一例表现为ST段抬高型心肌梗死（STEMI）的心肌心包转移病例以及恶性转移所致心脏损伤的临床特征。
一名78岁女性，有乳腺癌病史，近期诊断为肺梭形细胞癌，因转移出现进行性舌痛。其心电图显示I、aVL及V导联ST段抬高，III及aVF导联有对应性改变，背景为心房颤动。她无胸痛，但乳酸水平升高（6.6 mmol/L）及高敏肌钙蛋白T升高（45 ng/L）引起对STEMI的关注。冠状动脉造影显示无阻塞性冠状动脉疾病。超声心动图发现心肌内有一肿块延伸至心包。由于其肿瘤预后差，患者转为姑息治疗。
在晚期癌症中，应考虑心肌转移是持续性ST段抬高的原因之一。应优先进行超声心动图检查以识别结构异常，如恶性心肌浸润，而冠状动脉造影在临床有指征时对于排除急性心肌梗死仍至关重要。
