Key result
Small-cell lung cancer cardiac metastasis mimics lateral STEMI with nonobstructive coronaries and stable troponins.
Why the study?
ST-segment elevation in patients with cancer may reflect malignant myocardial-pericardial infiltration rather than acute coronary occlusion, requiring differentiation.
Case Report (n=1)
Cardiac metastasis must be considered as a STEMI mimic in oncology patients presenting with discordant electrocardiographic changes, nondynamic troponin kinetics, and nonobstructive coronary arteries.
Prompts consideration of cardiac metastasis in oncology patients with STEMI-like ECGs and nonobstructive arteries; leaves open prospective validation of diagnostic criteria.
BACKGROUND: ST-segment elevation in patients with cancer may reflect malignant myocardial-pericardial infiltration rather than acute coronary occlusion. CASE SUMMARY: A 68-year-old man with active small-cell lung carcinoma receiving chemotherapy presented with acute stabbing chest pain. Electrocardiography showed ST-segment elevation in leads I, aVL, and V2 with inferior reciprocal depression. Transthoracic echocardiography demonstrated anterolateral hypokinesia, focal myocardial discontinuity, and adjacent pericardial effusion. Emergent coronary angiography revealed nonobstructive coronary arteries, and initial high-sensitivity troponin values were nondynamic. Review of recent fluorodeoxyglucose positron emission tomography/computed tomography demonstrated intense hypermetabolic pericardial and adjacent myocardial involvement. One-month follow-up electrocardiography showed persistent ST-segment elevation without Q-wave evolution, with persistently mildly elevated but nondynamic troponin values. DISCUSSION: Multimodality correlation favored malignant myocardial-pericardial infiltration over acute coronary occlusion or isolated myocarditis. TAKE-HOME MESSAGE: Cardiac metastasis is an important ST-segment elevation myocardial infarction mimic in oncology patients.
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Erdoğdu et al. (2026) conducted a case report in Malignant myocardial-pericardial infiltration (cardiac metastasis) mimicking STEMI (n=1). Malignant myocardial-pericardial infiltration was evaluated. Cardiac metastasis from small-cell lung cancer can mimic lateral ST-segment elevation myocardial infarction, presenting with nonobstructive coronary arteries and nondynamic troponin kinetics.
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