Cardiac Tumor Masquerading as ST Elevation Myocardial Infarction: A Case Report and Literature Review

Abstract

Cardiac tumors are rare, with primary tumors much rarer than secondary. They can present with a variety of symptoms, including cardiogenic shock, arrhythmias, tamponade, and systemic embolism. There have been cases reported of patients having cardiac tumors presenting with ST elevations. While the exact pathophysiological mechanism for ST changes in patient with tumors is not known, proposed theories include tumor emboli to coronary artery, external compression of coronary arteries, stretching of cardiac muscle fibers, inflammatory reactions, and electrolyte transfer from necrotic tumor tissue to adjacent myocardium. We present a case in which the patient had no prior history of malignancy that are presented with cough, shortness of breath, lower extremity edema, ST elevation on electrocardiogram, and was found to have epithelioid tumor in his left ventricle. This case raises awareness of wide differential for ST changes on electrocardiogram besides myocardial infarction, especially in patients who do not present with classic ischemic symptoms.

Keywords: Cardiac tumor; ST elevation.

Figure 1:. Initial ECG showing sinus rhythm with acute ST elevation in V4-6, II, III, aVF.

Figure 2:. Evolving ECG changes showing widening of QRS in anterolateral leads and developing bundle branch block.

Figure 3:. Coronary angiogram demonstrating no obstructive coronary artery disease.

Figure 4a & 4b:

CT chest showing large pericardial effusion, massive left ventricle filling defect, and anterior bulging of the left ventricle along right ventricular apex.