Cardiac metastasis from epidermoid esophageal cancer mimicking anterior myocardial infarction

Cardiac metastases are more common than primary tumors. Several types of malignant tumors have been reported to metastasize to the heart, mainly lung cancer, but in the setting of esophageal cancer, myocardial metastasis is comparatively rare. We report a case of a cardiac metastasis from esophageal squamous cell carcinoma detected 9 months after surgically curative esophagectomy, which presented mimicking acute myocardial infarction. The use of different imaging modalities was fundamental to a correct diagnosis considering the challenging presentation.     

Intestinal obstruction mimicking acute myocardial infarction

A 64-year-old woman presented at our institution with abdominal pain. An electrocardiogram suggested the possibility of acute anteroseptal myocardial infarction. Her medical history included esophageal reconstruction with use of a jejunal conduit in the anterior mediastinum. Echocardiography revealed a distended jejunal conduit, which was compressing the right ventricle. Once the cause was identified, nasogastric suction was initiated and the symptoms and electrocardiographic changes resolved.     

Pancreatitis with electrocardiographic changes mimicking acute myocardial infarction.

A 64-year-old woman with mild acute pancreatitis presented with epigastric pain, nausea and vomiting while undergoing hemodialysis for chronic renal insufficiency. Serial electrocardiograms revealed new onset ST segment elevations in leads V2 to V4 mimicking an anterior myocardial infarction, followed by diffusely inverted deep T waves. No cardiac pathology was demonstrated by echocardiography or coronary angiography. A review of the literature and possible pathophysiological mechanisms of electrocardiographic changes in acute pancreatitis, such as metabolic abnormalities, hemodynamic instability, vasopressors, pericarditis, myocarditis, a cardiobiliary reflex, exacerbation of underlying cardiac pathology, coagulopathy and coronary vasospasm, are discussed.     

Pneumomediastinum mimicking acute ST-segment elevation myocardial infarction

Pneumomediastinum is characterized by dissecting air within the connective tissues supporting the mediastinum. This condition has been associated with multiple electrocardiographic abnormalities including T-wave inversion, electrical alternans, loss of R wave progression, and low voltage QRS. We describe a case of pneumomediastinum with electrocardiographic changes mimicking acute ST-segment elevation myocardial infarction. Laboratory studies and echocardiography demonstrated no evidence of myocardial injury, and the electrocardiographic abnormality promptly resolved with resolution of the pneumomediastinum. The apparent ST-segment elevation appeared to be the result of electrocardiographic artifact, possibly related to epidermal stretch synchronous with the cardiac cycles.     

Acute pancreatitis mimicking acute inferior myocardial infarction

A 56-year-old man presented with acute pancreatitis and electrocardiographic abnormalities, suggesting acute inferior myocardial infarction. An emergent coronary angiogram showed normal coronary arteries. The clinical significance and therapeutic implications of this rare finding are discussed.     

Hypercalcemia-induced ST-segment elevation mimicking acute myocardial infarction

We describe a patient who presented with abdominal pain radiating to the chest and ST elevation in the precordial leads, mimicking acute myocardial infarction. Urgent coronary angiography revealed normal coronary arteries and his serum troponin has not increased. Subsequently, he was found to have severe hypercalcemia. ST segment elevation resolved after correction of hypercalcemia. This phenomenon of ST elevation secondary to hypercalcemia has been described only two times in the English literature to date.     

Viral myocarditis mimicking acute myocardial infarction.

Anecdotal reports have shown that myocarditis can mimic acute myocardial infarction with chest pain, electrocardiographic (ECG) abnormalities, serum creatine kinase elevation and hemodynamic instability. Thirty-four patients with clinical signs and symptoms consistent with acute myocardial infarction underwent right ventricular endomyocardial biopsy during a 6.5-year period after angiographic identification of normal coronary anatomy. Myocarditis was found on histologic study in 11 of these 34 patients. Cardiogenic shock requiring intraaortic balloon support developed within 6 h of admission in three (27%) of the patients with myocarditis. The mean age of the group with myocarditis was 42 +/- 5 years. A preceding viral illness had been present in six patients (54%). The ECG abnormalities were varied and included ST segment elevation (n = 6), T wave inversions (n = 3), ST segment depression (n = 2) and pathologic Q waves (n = 2). The ECG abnormalities were typically seen in the anterior precordial leads but were diffusely evident in three patients. Left ventricular function was normal in six patients and globally decreased in the remaining five patients, whose ejection fraction ranged from 14% to 45%. Lymphocytic myocarditis was diagnosed in 10 patients, and giant cell myocarditis was detected in the remaining patient. Four patients with impaired left ventricular function received immunosuppressive therapy with prednisone and either azathioprine (n = 2) or cyclosporine (n = 2). All six patients whose left ventricular function was normal on admission remain alive in functional class I. Of the five patients with impaired systolic function, ejection fraction normalized in three of the four patients who received immunosuppressive therapy within 3 months of treatment and in the one patient who received only supportive therapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Primary cardiac tumor mimicking acute myocardial infarction (The 18th case)

病例摘要患者女性,52岁,既往无高血压、糖尿病史,2005年1月体检时心电图结果正常。2005年5月5日因“突发胸闷1h”就诊于急诊,体检双肺呼吸音清,未闻及干湿啰音;心脏听诊心律齐,未闻及杂音。血常规:白细胞6 .6×109/L,血红蛋白115 g/L;血沉:40 mm/h,血液各项生化检查、CK-MB、TnI均在正常范围。心电图提示:Ⅱ、Ⅲ和aVF导联ST段弓背样抬高、胸前导联ST段压低、T波倒置。根据患者症状和心电图检查,诊断为“急性下壁心肌梗死”,予抗凝、抗血小板和静脉溶栓治疗。2h后患者胸闷症状无明显缓解,心电图无动态变化,复查心肌酶仍在正常范围。行…     

Squamous cell lung cancer simulating an acute myocardial infarction

Lung cancer involvement of the heart is silent, carries a poor prognosis, and is most commonly identified at autopsy. A patient with lung cancer presented with symptoms and ECG findings suggestive of an acute coronary syndrome. Persistent symptoms and normal creatine phosphokinase (CPK) levels led to use of MRI and radionuclide scintigraphy to diagnose neoplastic infiltration of the myocardium. Palliative care was established with significant symptom relief. Assessment for cardiac metastases should be considered in patients with advanced lung cancer presenting with chest pain, new ECG findings, and normal CPK levels.     

Right ventricular ischemia mimicking acute anterior myocardial infarction.

Isolated right ventricular ischemia in combination with myocardial infarction (MI) is uncommon, accounting for fewer than 3% of all MI cases. A young man who presented with acute right ventricular ischemia from occlusion of a codominant right coronary artery proximal to an acute marginal branch is presented. His presenting electrocardiogram (ECG) showed ST segment elevation in V1 to V4 mimicking acute anterior MI. ECG criteria for isolated right ventricular ischemia are discussed.