Metastatic Cancer Masquerading as Acute Coronary Syndrome

Abstract

Patients with heart metastases could present insidiously, with symptoms that mimic those of congestive heart failure or acute coronary syndrome. Our patient initially presented with vague lower sternal and abdominal pain and had a past medical history of coronary artery disease. Her first two troponin levels were elevated, and her EKG was significant for ischemic changes. Echocardiography showed a large mass in the right ventricle and the presence of pericardial effusion. CT scan of the thorax, abdomen, and pelvis showed multiple pulmonary nodules as well as liver metastases. Our patient opted not to pursue further imaging such as cardiac MRI or a liver biopsy. It is imperative that medical professionals are aware of the presentational overlap between acute coronary syndrome and metastatic heart disease, in order to ensure proper diagnosis and management of the latter with echocardiography, cardiac MRI, and possibly surgery.

ST Segment Elevation in a Young Woman with Metaplastic Breast Carcinoma

“…Others are breast cancer, esophageal cancer, squamous cell carcinoma of the mouth, melanomas, and lymphomas. 9,[22][23][24][25] Apart from primary cardiac tumors, there are very few case reports of direct neoplastic infiltration into cardiac structures and coronary arteries, which are not associated with metastases. The most common are lung cancer and leukemias.…”

“…9,25) Antiarrhythmic or anticoagulant therapy and the pericardiocentesis or pericardial window should be followed if needed. 9,23,24) Innovative strategies in the treatment of metaplastic breast carcinoma targeting, among others, PIK3CA or NOS mutation are still at the stage of clinical trials. 5,6) In cancer patients suspected of cardiac involvement, the literature emphasizes the role of echocardiography, which, in combination with other imaging techniques such as CT or magnetic resonance, enables a precise assessment of tumor location, stage of advancement of myocardial infiltration, or extracardiac extension.…”

Cardiac metastasis from small cell lung cancer origin: A case report and review of the literature

“…2,5 Clinical manifestations of MCT vary widely and include arrhythmias, embolic phenomena or acute coronary syndrome. [8][9][10] Patients may also experience non-specific manifestations, such as fever, malaise and arthralgia. Shortness of breath is the most common symptom and cardiac tamponade is life threatening.…”

“…Clinical manifestations of MCT vary widely and include arrhythmias, embolic phenomena or acute coronary syndrome. 8 , 9 , 10 Patients may also experience non‐specific manifestations, such as fever, malaise and arthralgia. Shortness of breath is the most common symptom and cardiac tamponade is life threatening.…”