Persistent J-ST elevation: a sign of persistent perimyocardial irritation

摘要

Dear Editor: We greatly enjoyed reading the recently published case by Cudmore et al. The case emphasises the importance of keeping a broad differential and a low threshold for suspecting an ominous diagnosis viz. 'secondary pericardial metastasis or encroachment', especially with the history of a known systemic malignancy. Metastatic and infiltrative/invasive involvement of the pericardium may often be the initial sign of cardiac involvement as a result of malignant disease elsewhere. The most common initial presenting feature is a pericardial effusion or even more deceptively clinical spectrum and ECG changes resembling 'acute pericarditis', especially when a strong fibrinous inflammatory pericardial reaction ensues. Patients with 'metastatic or invasive pericarditis' often have J-ST elevations lasting for days to weeks, implying a persistent perimyocardial irritation. It is often in contrast to idiopathic or viral pericarditis where patients will exhibit dynamic 4-stage ECG changes. In the presented case, the patient had a subacute presentation with preceding clinical symptomatology of 2-week duration and initial ECG showed J-ST elevation suggesting persistent pericardial irritation.