Cardiac metastases can present with cardiovascular symptoms mimicking endocarditis or atrial myxoma even when the primary malignancy is clinically silent.
May prompt consideration of occult malignancy in unexplained murmurs; extends sparse case evidence on cardiac metastases from silent primaries.
In malignant disease, cardiac metastases occur late (Jefferson and Rees, 1973), are usually right-sided (Lymburner, 1934) and have been reported as an often unsuspected post-mortem finding in 10% of cases (Heath, 1968). We describe a patient who presented with cardiovascular symptoms due to a left atrial metastasis which made subacute bacterial endocarditis or atrial myxoma seem likely diagnoses. These symptoms arose at a time when malignant disease was not suspected and the primary gastric carcinoma was clinically silent. A 47-year-old housewife presented with a five-month history of lassitude, weight loss and shortness of breath. She had paroxysmal nocturnal dyspnoea on two occasions. On examination she appeared anaemic, had a persistent fever and a pan systolic murmur was audible over the apex. Investigations showed Hb 8.8 g; low iron and total iron binding capacity; plasma viscosity 2.12; albumen 2.7 g; globulin 4.2 g.
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O’Neill et al. (1979) studied this question.