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• W4387248828 abstract "SESSION TITLE: Rare Presentations of Cancer SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/09/2023 09:40 am - 10:25 am INTRODUCTION: Here we present a case of a Type II ST elevation MI with a unique etiology. CASE PRESENTATION: A 62-year-old female presented with shortness of breath and weakness. Past medical history included CAD, HFpEF, mAVR, DM2, HTN, and depression. Of note, she was recently found to have a new left-sided lingular lung mass with pathology showing poorly differentiated non-small cell lung carcinoma. On arrival she was found to be hypotensive and encephalopathic. ECG showed new onset atrial flutter with ST elevations in leads I and aVL and reciprocal ST depression in leads II, III, and aVF. CXR showed cardiomegaly. Initial high-sensitivity troponin was minimally elevated (125 ng/L) and stable with a negative 1hr delta. Bedside echo showed anterolateral wall hypokinesis without pericardial effusion. These findings were more consistent with subacute MI. Furthermore, as she also had a significantly supratherapeutic INR, she was not taken to the cath lab. Formal echo showed an echodense material that appeared contiguous with the LV. CT chest showed interval enlargement of a centrally necrotic and liquefied mass in the lingula, now inseparable from the left side of the heart. Due to rapid growth of the mass in just over a week and overall poor prognosis, the decision was made to not undergo further treatment and the patient was transitioned to hospice. DISCUSSION: ST elevation MI occurs due to complete occlusion of a coronary artery resulting in transmural infarction, usually due to acute plaque rupture leading to thrombosis, the classic mechanism of Type I MI. This is a rare case of mass effect from malignancy causing a STEMI via compression versus invasion of the coronary artery. Unfortunately this patient never underwent coronary angiogram, which is the gold standard for any STEMI. Sequential imaging showed rapid progression of metastatic disease. Interestingly, pathological involvement of myocardium by metastatic lung cancer and subsequent electrical alteration has been described and may result in persistent ST elevation mimicking ST-elevation MI. In our patient, there was an obvious wall motion abnormality in the territory supplied by the left circumflex artery. This finding along with a chronic pattern of troponin elevation supported the fact that the observed ST-elevations were secondary to supply-demand mismatch from worsening tumor compression or invasion, and as such would be considered a Type II STEMI. CONCLUSIONS: This case was a rare example of extrinsic compression or involvement of the left circumflex artery resulting in a Type II myocardial infarction that presented as a STEMI. REFERENCE #1: Jung, Hae Won MD∗. ST-segment elevation due to myocardial invasion of lung cancer mimicking ST elevation myocardial infarction: A case report. Medicine 100(20):p e26088, May 21, 2021. | DOI: 10.1097/MD.0000000000026088 REFERENCE #2: Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018 Nov 13;138(20):e618-e651. doi: 10.1161/CIR.0000000000000617. Erratum in: Circulation. 2018 Nov 13;138(20):e652. PMID: 30571511. DISCLOSURES: No relevant relationships by Michael Braccia No relevant relationships by Rahul Gupta No disclosure on file for Nauman Islam No relevant relationships by Dominic Parfianowicz No relevant relationships by Naveed Rahman" @default.
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• W4387248828 date "2023-10-01" @default.
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• W4387248828 title "A MALIGNANT CAUSE OF A TYPE II STEMI" @default.
• W4387248828 doi "https://doi.org/10.1016/j.chest.2023.07.2934" @default.
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