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

      case-report

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          Abstract

          Introduction

          In 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 presentation

          In 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.

          Conclusion

          Here, 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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          Most cited references11

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          The echocardiographic evaluation of intracardiac masses: a review.

          Priscilla Peters, Sean Reinhardt (2006)
          Echocardiography is an invaluable procedure for the evaluation of intracardiac masses, and can reliably identify mass location, attachment, shape, size, and mobility, while defining the presence and extent of any consequent hemodynamic derangement. With careful attention to mass location and morphology, and appropriate application of clinical information, echocardiography can usually distinguish between the 3 principal intracardiac masses: tumor, thrombus, and vegetation. Transesophageal imaging frequently adds additional important information to the assessment of mass lesions and should always be considered when image quality is inadequate or pertinent clinical questions remain unanswered with surface imaging. This review will focus on primary and metastatic tumors of the heart.
          Article 0 comments Cited 37 times – based on 0 reviews     Review now
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            Growth of hepatocellular carcinoma into the right atrium. Report of five cases.

            K Kobayashi, Y Kato, N Hattori … (1983)
            Five patients had hepatocellular carcinoma growing into the right atrium. Clinically, all patients had edema in the legs, venous dilatation in the abdominal wall, ascites, and dyspnea. Paroxysmal aggravation of dyspnea and its alleviation by a left decubitus position were noted in three patients. Three patients developed shock after a change in posture. A gallop rhythm in the cardiac murmur was detected in two. Pathologically, all livers had hepatocellular carcinoma and macronodular cirrhosis. At autopsy, a tumor thrombus was found that completely occluded the right hepatic vein and extended into the inferior vena cava and right atrium, partially occluding the inferior vena cava. Antemortem diagnosis of right atrial tumor thrombi in patients with primary hepatocellular carcinoma is difficult, but the condition should be suspected when dyspnea, abnormal cardiac sounds, and shock develop.
            Article 0 comments Cited 12 times – based on 0 reviews     Review now
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              Intracavitary metastatic hepatocellular carcinoma of the right ventricle.

              S. Lin, Mei-Ping Lu, Kwong Chieng … (2005)
              We report a rare case of direct intracavitary metastasis of a hepatocellular carcinoma (HCC) to the right ventricle (RV) without intravascular involvement. A 65-year-old female, with a history of HCC and partial right hepatectomy, developed symptoms of congestive heart failure. Echocardiography revealed a large tumor in the RV with extension to the outflow tract. Palliative excision of the cardiac tumor under cardiopulmonary bypass and cardioplegic arrest was performed due to severe hemodynamic compromise. The final pathology report disclosed metastatic HCC. Tumor recurrence in the RV was noted 2 months later and the patient succumbed to the disease.
              Article 0 comments Cited 6 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Vahit Demir
                Yasar Turan
                Hüseyin Ede
                Siho Hidayet
                Mustafa F. Erkoç
                Journal
                Journal ID (nlm-ta): Turk J Emerg Med
                Journal ID (iso-abbrev): Turk J Emerg Med
                Title: Turkish Journal of Emergency Medicine
                Publisher: Elsevier
                ISSN (Electronic): 2452-2473
                Publication date PMC-release: 17 July 2018
                Publication date Collection: January 2019
                Publication date (Electronic): 17 July 2018
                Volume: 19
                Issue: 1
                Pages: 33-35
                Affiliations
                [a ]Department of Cardiology, Medical Faculty of Bozok University, Adnan Menderes Bulvarı No:44, 66020, Yozgat, Turkey
                [b ]Department of Radiology, Medical Faculty of Bozok University, Adnan Menderes Bulvarı No:44, 66020, Yozgat, Turkey
                Author notes
                [∗ ]Corresponding author. vahit.demir@ 123456bozok.edu.tr
                Article
                Publisher ID: S2452-2473(18)30181-X
                DOI: 10.1016/j.tjem.2018.07.001
                PMC ID: 6370910
                SO-VID: cbfa99c1-5c94-4fae-b3c5-1cba36651deb
                Copyright © © 2019 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 12 June 2018
                Date revision received : 10 July 2018
                Date accepted : 11 July 2018
                Categories
                Subject: Case Report

                Data availability:

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