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

Jung, Hae Won

doi:10.1097/md.0000000000026088

Cited by 5 publications

(7 citation statements)

References 14 publications

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“…In most cases of previously reported cardiac metastases with STE, cardiac enzymes have been normal ( 5 ), unlike in our patient. The present case was initially misdiagnosed as STEMI due to STE accompanied by an elevation in hs-TNT.…”

Section: Discussioncontrasting

confidence: 72%

“…The changes in ECG, such as STE that mimics acute coronary syndrome, caused by secondary cardiac cancer mentioned in this article, are not the first reported, and many related studies (2)(3)(4)(5)(6)(7)(8) have recognized this phenomenon before. However, this is not just another example of STEMI misdiagnosis.…”

Section: Discussionmentioning

confidence: 94%

“…However, in our case, there was abnormal ST-segment elevation on precordial leads without the development of Q waves different from the typical ECG characteristics of STEMI. Several cases of cardiac metastasis mimicking STEMI have been reported (2)(3)(4)(5). ECG findings of localized STE without Q waves have high specificity for myocardial tumor invasion (6).…”

Section: Discussionmentioning

confidence: 99%

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Case report: Persistent ST-segment elevation due to cardiac metastasis from lung cancer

Zhan

Zhou

Wei

et al. 2023

Front. Cardiovasc. Med.

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Patients with secondary cardiac cancer occasionally show ST segment elevation that mimics acute coronary syndrome despite the absence of coronary artery occlusion. We herein describe a rare case of secondary cardiac cancer that presented with ST-segment elevation. An 82-year-old Chinese man was admitted to the hospital with chest discomfort. Electrocardiography (ECG) showed ST segment elevation in the precordial leads and low-voltage QRS complexes in limb leads without the development of Q waves. Unexpectedly, emergency coronary angiography showed no significant stenosis of the coronary arteries. However, fortunately, transthoracic echocardiography (TTE) revealed massive pericardial effusion and a mass at the apex of the ventricular myocardium. Coincidentally, contrast-enhanced chest computed tomography showed primary lung cancer in the left lower lobe, pericardial effusion, and myocardial metastasis at the ventricular apex. The pericardiac fluid contained blood with significantly increased CEA levels and exfoliated tumor cells. The lung histopathological report suggested squamous cell carcinoma. Two months later, the patient died. These findings suggested that the persistent ST-segment without the development of Q waves was associated with ventricular invasion by primary lung cancer and may indicate a poor prognosis. In conclusion, physicians should be aware of persistent ST-segment elevation mimicking myocardial infarction due to cardiac metastasis with a poor prognosis.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Case report: Persistent ST-segment elevation due to cardiac metastasis from lung cancer

Zhan

Zhou

Wei

et al. 2023

Front. Cardiovasc. Med.

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“…These tumors are often missed as they can grow silently for years and are later found after the patient's death upon autopsy findings. [ 3 ] Apical and anteroseptal areas of the heart are the most commonly involved sites. [ 4 ]…”

Section: Discussionmentioning

confidence: 99%

Myocardial invasion of squamous cell lung carcinoma presenting as STEMI

Anjum

Eajaz²,

Gaffar³

et al. 2022

Heart Views

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Myocardial invasion by a neoplasm is a rare occurrence that can present identical signs and symptoms of acute coronary artery disease. We report a case of a 53-year-old man diagnosed with squamous cell lung carcinoma who presented with chest pain and ST-segment elevation on an electrocardiogram. He underwent emergent coronary angiography, which ruled out coronary artery obstruction. An echocardiogram followed by magnetic resonance imaging of the heart confirmed metastatic lung mass in the left ventricular wall. The direct compression of a metastatic tumor on a myocardial wall could lead to ST-segment elevation mimicking acute coronary syndrome. Clinicians should consider metastatic myocardial tumor as a possible cause of ST-segment elevation in patients with nonobstructive coronary arteries and lung carcinoma to prevent misdiagnosis and resultant delayed treatment.

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“…Even after performing percutaneous coronary intervention (PCI) on the seventh day, ECG showed persistent ST-segment elevation. Elevated ST segment can be a non-specific diagnostic test for cardiac metastasis in patients with lung cancer [ 24 ]. Another case mimicking ST-segment elevation myocardial infarction (STEMI) in a patient with lung carcinoma turned out to have pericarditis instead of myocardial infarction (MI).…”

Section: Reviewmentioning

confidence: 99%

ST-Segment Elevation in Conditions of Non-cardiovascular Origin Mimicking an Acute Myocardial Infarction: A Narrative Review

Khurana¹,

Ranjan²

2022

Cureus

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The most widespread presenting ailments among patients visiting the emergency department are chest pain and shortness of breath. These symptoms lead any doctor to a probable diagnosis of myocardial infarction (MI). Detailed patient history, testing of blood samples for cardiac biomarkers that are indicative of cardiovascular necrosis, ultrasound methods, electrocardiography, and coronary computed tomography (CT) could all be beneficial to support the diagnosis. Out of these, electrocardiography is the most important and commonly done investigation in the emergency departments for patients presenting with chest pain and shortness of breath. However, interpreting these patients' electrocardiograms (ECGs) may be a matter of concern and worry. T wave and ST-segment changes are often of interest in the early signs of myocardial ischemia. Despite its incredible sensitivity, ST-segment deviation (elevated or depressed) has a low specificity because it can be seen in a variety of other cardiac and non-cardiac diseases. When ST-segment anomalies are identified, clinicians must consider many additional characteristics (such as risk factors, symptoms, and anamnesis), as well as all other possible diagnoses.All of these scenarios of patients presenting in the emergency department with chest discomfort and shortness of breath showing ST-segment abnormalities can leave a healthcare professional wondering whether to start treatment for acute myocardial infarction, through either the administration of a fibrinolytic agent, exposing patients to both the benefits and risks of fibrinolysis, or invasive coronary angiography. An astute physician may be able to recognize fabricated differential diagnosis mimicking STsegment elevation myocardial infarction (STEMI) in some situations. Failure to recognize these imposters can result in inefficient resource utilization, which can expose patients to unjustified risk and increased rather than decreased death and morbidity. Since the danger of cerebral hemorrhage from blood thinners is significant, in patient-care scenarios, in order to rule out percutaneous coronary intervention (PCI), a thorough assessment of the ECG is essential to consider diseases other than acute myocardial infarction, especially the ones that are non-cardiac in origin. The goal of this narrative review is to give an overview of the significant disorders that are non-cardiac in origin that can mimic an ST-segment elevation myocardial infarction (STEMI).

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

Cited by 5 publications

References 14 publications

Case report: Persistent ST-segment elevation due to cardiac metastasis from lung cancer

Case report: Persistent ST-segment elevation due to cardiac metastasis from lung cancer

Myocardial invasion of squamous cell lung carcinoma presenting as STEMI

ST-Segment Elevation in Conditions of Non-cardiovascular Origin Mimicking an Acute Myocardial Infarction: A Narrative Review

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