Case Report: Complete heart block as a manifestation of cardiac metastasis of oral cancer

Abstract

Metastatic tumors of the heart presenting with complete heart block (CHB) is an extremely uncommon case. There are no available guidelines in managing CHB in terminal cancer. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. We report a case of a 24-year-old man suffering from tongue cancer presenting with CHB. An intracardiac mass and moderate pericardial effusion were present, presumed as the metastatic tumor of tongue cancer. We implanted a temporary pacemaker for his symptomatic heart block and cardiogenic shock, and pericardiocentesis for his massive pericardial effusion. We decided that a permanent pacemaker would not be implanted based on the low survival rate and significant comorbidities. Multiple studies report a variable number of cardiac metastasis incidence ranging from 2.3% to 18.3%. It is rare for such malignancies to present with CHB. The decision to implant a permanent pacemaker is highly specific based on the risks and benefits of each patient. It needs to be tailored to the patient’s functional status, comorbid diseases, prognosis, and response to conservative management.

A case of atrial fibrillation complicated by complete atrioventricular block

“…Malnutrition in malignancy results from a combination of reduced synthetic function, gastrointestinal malabsorption, increased renal protein losses and eventually attenuated oral intake. 17 Ultimately, this cumulates in myocardial atrophy and a reduction in cardiac output. Impaired myocardial function promotes the development of arrhythmias including complete AV block.…”

“…Both arrhythmias share several common aetiologies, the most pertinent of which is ischaemic heart disease. 5,6,[10][11][12][13][14][15][16][17][18][19][20] Although an acute myocardial infarction was excluded with serial troponin T-tests which demonstrated no significant rise and serial ECGs which confirmed an absence of dynamic ischaemic changes, the potential of a previous myocardial infarction and/or ongoing chronic ischaemia cannot be excluded. ECGs performed 12 months ago and on admission (Figures 1 and 2) exhibited pathological Q waves in the inferior leads (II, III and aVF) along with prominent R waves in the anteroseptal leads (V1 and V2).…”

A Rare Case of Cervical Cancer Metastasis to the Heart

“…6,7 While arrhythmias and conduction blocks have been reported with cardiac metastasis, they are exceedingly rare. 8…”