Lung cancer presenting with acute myocardial infarction and pulmonary embolism within 1 month

Abstract

Acute myocardial infarction and pulmonary embolism can have life-threatening consequences such as congestive heart and respiratory failure, respectively. Cancer patients are at great risk of both acute myocardial infarction and pulmonary embolism complications because the malignancy sparks the patient's blood hypercoagulable state. Nevertheless, the literature currently offers only a few reports on acute myocardial infarction associated with pulmonary embolism, and two of them occurred in the same cancer patient. Here, we present a case of a 60-year-old woman who had been diagnosed with lung cancer. She was admitted to the emergency department twice. She was diagnosed with acute myocardial infarction at her first admission, when she experienced sudden-onset chest pain. Electrocardiography showed ST-segment elevation in leads V1-V3 with inverted T wave and pathological Q wave, suggesting an acute myocardial infarction. Coronary angiography revealed a thrombus in the left anterior descending coronary artery, and thrombus aspiration was performed. After 1 month, she had an attack of pulmonary embolism with syncope upon the second admission. A computed tomographic pulmonary angiography showed branches of right and left pulmonary embolism. Anticoagulation and antiplatelet measures were taken. In this article, we discuss the relationship between cancer and thrombosis with a special focus on the conservative management strategy regarding anticoagulant and antiplatelet therapy in our case.

Keywords: Acute myocardial infarction; cancer-associated thrombosis; pulmonary embolism.

Figure 1.

(a) Electrocardiogram (ECG) displaying ST-segment elevation in leads V1–V4 with pathological Q waves. (b) ECG showing sinus rhythm with ST-segment elevation in leads V1–V4 with inverted T waves and pathological Q wave formation in chest leads.

Figure 2.

Still-frame images of coronary angiography: (a) Normal right coronary artery. (b) and (c) Normal left circumflex artery and total occlusion of the proximal left anterior descending coronary artery (asterisk). (d) Placement of aspiration catheter (asterisk). (e) and (f) Post-aspiration angiography demonstrating thrombolysis in myocardial infarction 3 flow.

Figure 3.

(a) and (b) CT scans displaying signs of central bronchogenic carcinoma in the inferior lobe of the left lung with atelectasis and obstructive pneumonia (red arrows). (c) and (d) Computed tomographic pulmonary angiography showing pulmonary embolism in the basal segment of the right upper and lower lobe and its branches, as well as in the anterior segment of the left upper lobe (red arrows).