Complete Heart Block and Massive Pericardial Effusion as the Presenting Manifestations of Metastatic Colorectal Adenocarcinoma

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Metastatic colorectal adenocarcinoma with cardiac metastasis (n=1). Intervention: Pericardial fluid drainage and pacemaker implantation.

Q: What does this research mean for the field?

Pericardial fluid drainage and permanent pacemaker implantation can achieve clinical improvement in patients presenting with complete heart block and massive pericardial effusion secondary to metastatic colorectal adenocarcinoma. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Janine Ann F. Pangandian; John Reynaldo G. Viola; Lovely Dawn Terosio; Dawn Lynn Guardiario-Cavanaugh

doi:10.1016/j.jaccas.2026.108747

July 1, 2026JACC Case ReportsOpen Access

Complete Heart Block and Massive Pericardial Effusion as the Presenting Manifestations of Metastatic Colorectal Adenocarcinoma

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Key result

Urgent pericardiostomy and pacing resolve complete heart block from metastatic rectal adenocarcinoma.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Cardiac metastasis from colorectal cancer is exceedingly rare, with low clinical detection during life because most cases remain clinically silent.

Key Points

To describe the presentation, diagnosis, and acute management of concurrent complete heart block and massive pericardial effusion secondary to metastatic rectal adenocarcinoma.
Evaluated a 41-year-old woman presenting with progressive dyspnea and syncope who had a history of stage IIIC (pT4aN2bM0) rectal adenocarcinoma treated with surgery and adjuvant chemotherapy.
Conducted 12-lead electrocardiography, 2-dimensional echocardiography, pericardiocentesis, pericardial biopsy, FDG-PET imaging, and subsequent permanent pacemaker implantation.
Electrocardiography revealed third-degree atrioventricular block with an incomplete left bundle branch block pattern, and echocardiography identified a large pericardial effusion with right ventricular diastolic collapse.
Pericardial fluid cytology and tissue biopsy confirmed metastatic adenocarcinoma, and prompt drainage followed by pacemaker placement restored hemodynamic stability, maintaining stable cardiac symptoms at 5-month follow-up.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 41-year-old woman with a history of locally advanced rectal adenocarcinoma presenting with complete heart block and massive pericardial effusion due to cardiac metastasis.

I

Intervention

Tube pericardiostomy (pericardial fluid drainage) and single-chamber ventricular pacemaker implantation, followed by systemic chemotherapy (folinic acid, 5-fluorouracil, and irinotecan).

O

Outcome

Clinical improvement, hemodynamic stability, and rhythm stability.

Cardiac metastasis from rectal adenocarcinoma can present with life-threatening complications such as complete heart block and cardiac tamponade, requiring prompt multidisciplinary intervention including pericardiocentesis and pacing.

Limitations

Financial constraints delayed permanent pacemaker implantation and prevented molecular biomarker testing.
Financial constraints restricted access to optimal treatment interventions, including a pleuropericardial window, dual-chamber pacemaker, and molecular biomarker testing.

Implication

Consider cardiac metastasis in colorectal cancer with new conduction block; this case leaves open optimal surveillance strategies.

Abstract

BACKGROUND: Colorectal cancer is the most prevalent gastrointestinal cancer in Asia. Cardiac metastasis is exceedingly rare, and clinical detection during life is low as most cases remain clinically silent. CASE SUMMARY: A 41-year-old woman with a history of locally advanced rectal adenocarcinoma, who previously underwent upfront surgery and adjuvant chemotherapy, presented with progressive dyspnea and recurrent syncope. Evaluation revealed complete heart block and a large pericardial effusion. Pericardial fluid drainage was immediately performed, and a permanent pacemaker was subsequently implanted, resulting in clinical improvement. DISCUSSION: This case highlights extensive cardiac infiltration manifesting 2 life-threatening cardiac manifestations in a recurrent rectal adenocarcinoma, underscoring the importance of immediate interventions. TAKE-HOME MESSAGES: In retrospect, the absence of total neoadjuvant therapy in the initial management may have contributed to early recurrence of rectal cancer. Prompt and coordinated multidisciplinary interventions are crucial in a critical cardiac metastatic disease to improve survival and quality of life.

Discussion

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Cite This Study

Pangandian et al. (2026) conducted a case report in Metastatic colorectal adenocarcinoma with cardiac metastasis (n=1). Pericardial fluid drainage and pacemaker implantation was evaluated. Extensive cardiac metastasis from recurrent rectal adenocarcinoma manifested as complete heart block and massive pericardial effusion in a 41-year-old woman, requiring urgent pericardial drainage and pacemaker implantation.

synapsesocial.com/papers/6a5b38f68167787360d24de1 https://doi.org/10.1016/j.jaccas.2026.108747

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Complete Heart Block and Massive Pericardial Effusion as the Presenting Manifestations of Metastatic Colorectal Adenocarcinoma

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Complete Heart Block and Massive Pericardial Effusion as the Presenting Manifestations of Metastatic Colorectal Adenocarcinoma

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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