A leading cause of cardiovascular morbidity and death is ST-segment-elevation myocardial infarction (STEMI).1 Myocardial ischemia occurs when diminished blood supply to the heart cannot meet the demand of the myocardium. Infarction can occur when this supply-and-demand mismatch leads to cell necrosis. Usually, STEMI is caused by an occlusive thrombus and is typically recognized on electrocardiography (ECG) from the presence of ST-segment elevation (STE). Clinically, the diagnosis of acute myocardial infarction is reached after the detection of a rise or fall of cardiac biomarker values with at least one of the following: symptoms of ischemia; new or presumed new STE at the J point in at least 2 contiguous leads of ≥2 mm (0.2 mV) in men or ≥1.5 mm (0.15 mV) in women in leads V 2 and V 3 , and/or of ≥1 mm (0.1 mV) in other contiguous chest leads or the limb lead; the development of pathologic Q waves; imaging evidence of new loss of viable myocardium or new regional wall-motion abnormality; or the identification of an intracoronary thrombus on angiograms or at autopsy.2,3 ST-segment elevation can also be seen in other clinical contexts, including normal variants, left ventricular hypertrophy, left bundle branch block, pulmonary embolism, and pericarditis. 4 We describe the case of a woman with advanced adenocarcinoma of the lung who presented with STE in the presence of a lung mass close to the heart but with no objective evidence of myocardial ischemia.
Case ReportIn December 2011, a 51-year-old woman presented at the emergency department with a 3-day history of worsening nausea, weakness, and upper abdominal pain. She reported no chest discomfort or dyspnea. Her medical history included hypertension and former tobacco use. She had recently been diagnosed with poorly differentiated adenocarcinoma of the lung with metastases to the brain, peritoneum, and gluteal and paraspinal muscles. The malignancy had been treated with left-upper-lobe wedge resection, gamma-knife radiation to the brain, and systemic chemotherapy with use of carboplatin and pemetrexed. On presentation, the patient's temperature was 37.2 °C; heart rate, 114 beats/min; blood pressure, 93/74 mmHg; respiratory rate, 15 breaths/ min; and pulse oximetry, 99% on 2 L of oxygen. Results of physical examination included a jugular venous pressure of 7 cm H 2 O, normal heart sounds, and no murmurs, rubs, or gallops. Auscultation revealed mild bilateral end-expiratory wheezes and
