Misdiagnosis  Cardiac Metastasis Presented as a Pseudo-Infarction on Electrocardiography

Pan, Kuo‐Li; Wu, Lung Sheng; Chung, Chang Min; Chang, Shih Tai; Lin, Pi Chi; Hsu, Jen Te

doi:10.1536/ihj.48.399

Cited by 11 publications

(3 citation statements)

References 16 publications

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“…The ST segment elevation was due to a metastatic tumor that invaded the pericardium and myocardium. Suggested mechanisms for these pseudo-infarction ECG patterns are continuous myocardial injury preventing formation of new cardiac cell membrane, stretched adjacent muscle fibers, inflammatory reaction, the ionic transfer of potassium from necrotic tissue to the adjacent myocardium, and transfer of potassium from damaged tissue to the adjacent myocardium producing electropotential differences 8 . A similar cardiac metastasis of bladder cancer, which ECG abnormality was reported by Na et al.…”

Section: Discussionmentioning

confidence: 67%

Electrocardiographic changes in right ventricular metastatic cardiac tumor mimicking acute ST elevation myocardial infarction: A case of misdiagnosis

Demir

Turan

Ede

et al. 2019

Turkish Journal of Emergency Medicine

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IntroductionIn patients with ST elevation myocardial infarction (STEMI), minimizing the reperfusion time is the goal of therapy worldwide. However, the differential diagnosis is critical and when a patient is encountered with chest pain and ST elevation, STEMI should not be the only diagnosis considered. By detailed history and focused physical examination, it is possible to avoid a mistaken diagnosis.Case presentationIn this report, we present a case of a male patient with tongue cancer and accompanying myocardial metastasis that causes electrocardiographic changes, who was initially misdiagnosed with ST elevation myocardial infarction.ConclusionHere, we reported a case of metastatic cancer in the heart which was initially diagnosed as acute myocardial infarction. Echocardiography, computed tomography and magnetic resonance imaging of the heart were used accordingly to confirm the myocardial metastasis.

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Section: Discussionmentioning

confidence: 67%

Electrocardiographic changes in right ventricular metastatic cardiac tumor mimicking acute ST elevation myocardial infarction: A case of misdiagnosis

Demir

Turan

Ede

et al. 2019

Turkish Journal of Emergency Medicine

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“…El hallazgo de una elevación del segmento ST como forma de presentación de las tumoraciones cardíacas es muy infrecuente y puede deberse a la compresión tumoral de una arteria coronaria o a la invasión miocárdica. A nivel celular, varios son los mecanismos que podrían explicar una elevación persistente del segmento ST. Entre ellos pueden citarse el desarrollo de una corriente de injuria secundaria a una reacción inflamatoria peritumoral; la transferencia iónica de potasio desde el tejido necrótico al miocardio adyacente, lo que produce una diferencia de potencial eléctrico entre estas áreas y, finalmente, el estiramiento de las fibras musculares adyacentes que llevan a una corriente de injuria similar a la que ocurre en los aneuris-mas ventriculares (2,3) . En nuestro caso, la angiografía evidenció una disminución de calibre del ramo posterolateral, que podría corresponder a compresión tumoral extrínseca (figura 2).…”

Section: Discussionunclassified

Supradesnivel del segmento st como forma de presentación de un tumor cardiaco. Rol de la resonancia magnética para su diagnóstico

2021

Rev.Urug.Cardiol.

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Supradesnivel del segmento ST como forma de presentación atípica de un tumor cardíaco. Rol diagnóstico de la multimodalidad de imagen ResumenLos tumores cardíacos malignos son neoplasias poco frecuentes que pueden presentarse de diversas formas, lo que dificulta su diagnóstico. La ecocardiografía y la resonancia magnética cardíaca son técnicas fundamentales para el diagnóstico, la caracterización y la evaluación de su extensión tumoral. La identificación de la línea tumoral es esencial al iniciar un tratamiento oncológico dirigido. Si bien el "estándar de oro" para este fin es el estudio anatomopatológico (obtenido por biopsia o resección quirúrgica), en los casos en que esto no es posible, la resonancia magnética cardíaca es la técnica no invasiva que proporciona un mejor abordaje diagnóstico. El tratamiento de elección es la resección quirúrgica y el pronóstico, en general, es malo. Presentamos el caso de una paciente con un tumor cardíaco de presentación clínica atípica, en la que un abordaje imagenológico multimodal aporta información clave y complementaria para el diagnóstico y la caracterización tisular. Palabras clave:Tumor cardíaco maligno Sarcoma indiferenciado Multimodalidad Resonancia magnética cardíaca ST segment elevation as an atypical presentation of a cardiac tumor. Diagnostic role of a multimodal imaging approach SummaryMalignant cardiac tumors are rare neoplasms that can present in various forms, making their diagnosis difficult. Echocardiography and cardiac magnetic resonance imaging are fundamental techniques for the diagnosis, characterization, and evaluation of tumor extension. Identification of the tumor line is essential when initiating targeted cancer therapy. Although the "gold standard" for this purpose is the pathological study (obtained by biopsy or surgical resection), in cases where this is not possible, cardiac resonance is the non-invasive technique that provides a better diagnostic approach. The treatment of choice is surgical resection and the prognosis is generally poor. We present the case of a patient with an atypical clinical presentation, in which a multimodal approach provides key and complementary information for tumor diagnosis and tissue characterization.

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“…Increased thoracic pressure may also interfere with the amount and type of matter between the heart and the chest wall [6]. Other mechanisms can be due to direct stretch and irritation of the cardiac myocytes and electrolyte abnormalities caused by a nearby hypermetabolic, damaged tissue [8]. The location and nature of this esophageal malignancy make the correlation possible ( Figure 2).…”

Section: Discussionmentioning

confidence: 99%

A Pseudo-Infarction Pattern in the Setting of Esophageal Malignancy

Maaliki¹,

Verdecia²,

Nelson³

et al. 2020

Cureus

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A 57-year-old African American male was admitted for workup of unintentional weight loss. He was found to have an esophageal squamous cell carcinoma. Electrocardiogram (ECG) readings demonstrated deep Q waves in leads V1-V2 with T wave flattening, which raised concern for a septal infarct. Myocardial infarction (MI) was subsequently ruled out through clinical, imaging, and laboratory analysis. The ECG findings were deemed as a pseudo-infarct pattern in the setting of squamous cell carcinoma of the esophagus.

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Misdiagnosis Cardiac Metastasis Presented as a Pseudo-Infarction on Electrocardiography

Cited by 11 publications

References 16 publications

Electrocardiographic changes in right ventricular metastatic cardiac tumor mimicking acute ST elevation myocardial infarction: A case of misdiagnosis

Electrocardiographic changes in right ventricular metastatic cardiac tumor mimicking acute ST elevation myocardial infarction: A case of misdiagnosis

Supradesnivel del segmento st como forma de presentación de un tumor cardiaco. Rol de la resonancia magnética para su diagnóstico

A Pseudo-Infarction Pattern in the Setting of Esophageal Malignancy

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