Cardiac Metastasis of Pulmonary Spindle Cell Carcinoma Mimicking Lateral ST-Segment Elevation Myocardial Infarction.

BACKGROUND

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.

CASE SUMMARY

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.