Metastatic squamous cell carcinoma to the heart: an unusual cause of ST elevation—a case report

Abstract

Background Cardiac tumours are typically secondary in nature, and the most common malignancies metastasizing to the heart are cancers of the lung, breast, oesophagus, melanoma, and lymphoma. We present a unique case of squamous cell carcinoma of the tongue, metastasizing to the heart and manifesting with ST elevation in the inferior-leads on electrocardiogram (ECG). Case summary A 25-year-old woman was initially diagnosed with squamous cell carcinoma of the tongue at the age of 23 and treated with hemi-glossectomy with clear-margins. Sixteen months later, the tumour recurred in the oropharynx and the left upper lobe of the lung. She was treated with chemotherapy; however, the tumour progressed. Thus, she was initiated on immunotherapy and radiation therapy. One month later, she presented with chest pain. Electrocardiogram revealed ST elevation in the inferior-leads. Troponin-I was elevated. Transthoracic echocardiogram revealed focal areas of thickening within the left and right ventricular myocardium with associated hypokinesis. These findings suggested ECG changes were likely secondary to infiltrative metastases and not acute-coronary-syndrome. Cardiac magnetic resonance imaging showed infiltrative masses with increased T2-signal and heterogeneous enhancement on perfusion and delayed enhancement sequences. Imaging also demonstrated numerous extra-cardiac metastases. She was treated with analgesics and discharged to home hospice. Discussion Head and neck cancers are a rare cause of cardiac metastasis. ST elevation and troponin release are thought to be due to tumour extension into the myocardium. Cardiac metastases usually present in patients with advanced widespread malignancy. In a cancer patient with cardiac symptoms or ECG changes, it is important to consider a broad differential diagnosis and entertain the possibility of cardiac metastasis.

ST-segment elevation due to myocardial invasion of lung cancer mimicking ST elevation myocardial infarction

“…[ 6 ] Several case reports of cardiac metastasis mimicking STEMI have been reported. [ 2 , 8 – 10 ] For these reasons, periodic ECG is necessary for cancer patients and rapid cardiac work-up is recommended especially, when ST-segment elevation is newly discovered. If ST-segment elevation is newly found in cancer patients, STEMI, takotsubo cardiomyopathy, myopericarditis, myocardial metastasis, hyperkalemia, pulmonary embolism should be considered as differential diagnoses.…”

“…If ST-segment elevation is newly found in cancer patients, STEMI, takotsubo cardiomyopathy, myopericarditis, myocardial metastasis, hyperkalemia, pulmonary embolism should be considered as differential diagnoses. [ 2 ] Still, the mechanism of ST-segment elevation in myocardial metastasis have not been fully understood. However, it characterized by persistent ST-segment elevation without typical ECG changes of MI such as the development of Q waves in consecutive ECGs [ 2 ] and the leads with ST-segment elevation may reflect the location of the myocardial involvement, similar to those of STEMI patients.…”

“…[ 2 ] Still, the mechanism of ST-segment elevation in myocardial metastasis have not been fully understood. However, it characterized by persistent ST-segment elevation without typical ECG changes of MI such as the development of Q waves in consecutive ECGs [ 2 ] and the leads with ST-segment elevation may reflect the location of the myocardial involvement, similar to those of STEMI patients. [ 9 ] Like our patient, in most cases of previously reported ST-segment elevated cardiac metastases, cardiac enzymes were normal.…”

“…It features persistent ST-segment elevation without typical ECG changes of infarction. [ 2 ] Here, we present a rare case of 1 patient with ST-segment elevation due to myocardial invasion of lung cancer mimicking ST-segment elevation myocardial infarction (STEMI).…”

Rare Case of Asymptomatic Cardiac Metastasis in a Patient of Laryngeal Squamous Cell Carcinoma

“…Clinical presentations of cardiac metastases are extremely variable. Although a cardiac metastasis may be the first or even the only manifestation of an undiagnosed malignant neoplasm, they often go unrecognized in vivo and are diagnosed only after death (Tandon et al, 2019). In general, although a focal lesion secondary to the myocardium may result in unclear symptoms that may go undetected, tumors spreading more extensively to the pericardium or to other cardiac sites may produce dramatic clinical patterns, causing medical emergencies (Kim et al, 2019).…”