An unusual myocardial infarction

Abstract

We present a 74-year-old male with a chondrosarcoma, who presented with chest pain. The history, electrocardiogram (ECG), and biomarkers established the diagnosis of myocardial infarction (MI); angiography did not show coronary atherosclerosis and, both initial transthoracic echocardiogram and chest computed tomography (CT), did not demonstrate any cardiac abnormalities. A second echocardiogram following a routine ECG showed presence of a mass involving the right ventricle and the cardiac apex that was confirmed by chest CT scan. We underline the importance of considering cardiac tumors in the clinical arena of MI management.

Learning points: Cardiac tumors cause ECG changes similar to ischemic heart diseases.Keep in mind cardiac tumors when performing transthoracic echocardiogram (TTE) in the setting of suspected MI.TTE is the technique of choice in detecting cardiac tumors.

Figure 1

Electrocardiography. (A) ST elevation in precordial leads from V1 to V5 and the right bundle branch block. (B) Increase in elevation in precordial leads.

Figure 2

Transthoracic echocardiography: apical four-chamber view; presence of a large, nonhomogeneous mass infiltrating the diaphragmatic wall occupying the most of the apical right ventricular cavity can be observed. Its shape was multilobulated and its margins were defined. The entire whole myocardial apex showed an increase in echogenicity. Thin arrows: the right apical ventricle cavity is almost completely obliterated; mass involving right ventricular wall; thick arrow: mass involving the cardiac apex. ra, right atrium; la, left atrium; lv, left ventricle; details in the text.

Figure 3

Chest computed tomography scan: hypodense, irregular, large nonhomogeneous right ventricular mass, which appeared to infiltrate not only the right ventricular wall (thin arrows) but also the apex (thick arrow) and the interventricular septum.