A Rare Case of Left Ventricular Myocardial Metastasis of Patient Presenting with ST-Elevation Acute Coronary Syndrome

Myocardial Metastasis

Abstract

Lung cancer affected 2.2 million people and caused 1.8 million deaths in 2020.  The most common type is non-small-cell lung cancer (NSCLC), with symptoms like cough, dyspnea, pain, and weight loss. Metastases often occur in the brain and the adrenal glands. Cardiac metastasis, detected in 25% to 30% of autopsy examinations of patients, generally involves the pericardium. Rarely, lung cancer metastasizes to the myocardium and can mimic acute coronary syndrome (ACS) or ST-elevation myocardial infarction (STEMI) without coronary artery blockage. Prognosis is generally poor in patients with cardiac metastasis, as patients showing ACS-like symptoms may die within days. These highlight the need for clinicians to be aware of this rare but severe complication of lung cancer. This case report presents a rare occurrence of myocardial metastasis from primary lung cancer, which is presented as ACS. PET-CT scans of the patient demonstrated lung lesions, lymphadenopathy, and multiple metastases. Biopsy specimens revealed poorly differentiated squamous cell carcinoma, with possible high-grade mucoepidermoid carcinoma. Physicians should recognize that lung cancer metastasis to the heart can mimic ACS or STEMI without coronary blockage. Recognizing that ACS-like symptoms and ECG changes in a cancer patient may be the result of myocardial metastasis prevents misdiagnosis and inappropriate treatments. Transthoracic echocardiography (TTE) should be considered as the initial imaging modality, followed by Cardiac MRI, CT, and PET-CT.  As cardiac metastasis signals advanced cancer and poor prognosis, physicians should prioritize accurate diagnosis and can collaborate timely, with other specialists to initiate appropriate care such as radical surgical resection, radiotherapy and chemotherapy.