Acute myocardial infarction secondary to direct myocardial infiltration by a malignant neoplasia.

摘要

A 24-year-old male, with a previous history of osteosar-coma with cerebral and pulmonary metastasis, presented to the emergency room with severe chest pain, dyspnoea, and diaphoresis. Physical examination revealed an apical S4 gallop, abolition of left breath sounds, and right hemipare-sia. On electrocardiogram, persistent lateral ST-segment elevation was noted (Panel A). Echocardiogram showed lateral akinesis with global left ventricular ejection fraction preserved, severe pericardial effusion probably related to the malignant neoplasia, and infiltration of mediastinum by the pulmonary metastasis (arrows, Panel 8). He was referred for urgent coronary angiography, which revealed no significant stenosis (Panels C and D). Interestingly, ventri-culography showed a great distance between epicardic coronary arteries and left ventricular cavity (Panel £). Magnetic resonance imaging was performed and confirmed the direct infiltration of the neoplasia in the pericardium and myocardium (arrows, Panel F). The patient was treated with anti-ischaemic and opiate analgesic drugs and died a few days later by respiratory failure.