Metastatic Oropharyngeal Squamous Cell Carcinoma Presenting as an ST-Elevation Myocardial Infarction (STEMI) in a 55-Year-Old Male

A 55-year-old Hispanic male was admitted to the medicine service for tachycardia and shortness of breath of onset three to four days prior to arrival. His prior medical history was notable for Stage IVa oral squamous cell carcinoma (OSCC) with post subtotal glossectomy, floor of the mouth resection with segmental mandibulectomy, bilateral selective neck dissection (SND) of cervical levels I-IV, and chemoradiation therapy. His post-treatment positron emission tomography (PET) showed no metastatic disease. His electrocardiogram (ECG) was notable for ST elevations in leads III, aVF, V3, and V4 concerning for an inferior wall ST-elevation myocardial infarction (STEMI) requiring emergent cardiac catheterization, which ultimately revealed no coronary obstruction. A CT angiogram of the chest was obtained to rule out pulmonary embolism but incidentally revealed a new pericardial and left pleural effusion, as well as an enlarged left supraclavicular lymph node concerning for possible metastatic disease. A transthoracic echocardiogram revealed a mass-like structure in the pericardium. A biopsy of the pericardium and lymph node revealed metastatic SCC. Due to negative cardiac catheterization findings, the patient's ECG changes were thought to be secondary to metastatic disease. Head and neck cancer rarely metastasizes to the heart. The onset of new chest pain or shortness of breath in the setting of malignancy should be carefully evaluated for ACS but also merits evaluation for metastatic disease as evidenced by this patient's clinical presentation.