A STEMI Mimic
Dongbo Yu, M.D., Ph.D., and John E.A. Blair, M.D.
https://www.nejm.org/doi/full/10.1056/NEJMicm1810236?query=oncology-hematology
An 84-year-old man presented to the emergency department with generalized weakness and shortness of breath. Electrocardiographic results aroused concern that he had an ST-segment elevation myocardial infarction (STEMI), and the patient was transferred to a hospital that had a cardiac catheterization laboratory. On arrival at the second hospital, the patient had no chest pain. An electrocardiogram showed ST-segment elevation in leads I, aVL, and V2 through V6 (Panel A). The troponin I level was 0.15 ng per milliliter (reference value, <0.03). On further discussion with the patient and review of the records, it was discovered that the patient had been hospitalized 1 month earlier because of unintentional weight loss. Computed tomography (CT) of the chest at that time revealed a large intrathoracic mass invading the left ventricle (Panel B). CT-guided needle biopsy during that hospitalization revealed poorly differentiated non–small-cell carcinoma. An electrocardiogram during that hospitalization showed ST-segment elevations in a similar pattern, but they had become more prominent by the time of the second admission. This pattern was thought to be due to tumor invasion of the myocardium, and coronary angiography was not performed. After a discussion of treatment options with the patient and his family, the decision was made not to pursue surgery or chemotherapy. Goals of care were transitioned to focus on the patient’s comfort, and he died several days later.
Dongbo Yu, M.D., Ph.D.
John E.A. Blair, M.D.
University of Chicago Medical Center, Chicago, IL
jblair2@medicine.bsd.uchicago.edu
Dongbo Yu, M.D., Ph.D., and John E.A. Blair, M.D.
https://www.nejm.org/doi/full/10.1056/NEJMicm1810236?query=oncology-hematology
An 84-year-old man presented to the emergency department with generalized weakness and shortness of breath. Electrocardiographic results aroused concern that he had an ST-segment elevation myocardial infarction (STEMI), and the patient was transferred to a hospital that had a cardiac catheterization laboratory. On arrival at the second hospital, the patient had no chest pain. An electrocardiogram showed ST-segment elevation in leads I, aVL, and V2 through V6 (Panel A). The troponin I level was 0.15 ng per milliliter (reference value, <0.03). On further discussion with the patient and review of the records, it was discovered that the patient had been hospitalized 1 month earlier because of unintentional weight loss. Computed tomography (CT) of the chest at that time revealed a large intrathoracic mass invading the left ventricle (Panel B). CT-guided needle biopsy during that hospitalization revealed poorly differentiated non–small-cell carcinoma. An electrocardiogram during that hospitalization showed ST-segment elevations in a similar pattern, but they had become more prominent by the time of the second admission. This pattern was thought to be due to tumor invasion of the myocardium, and coronary angiography was not performed. After a discussion of treatment options with the patient and his family, the decision was made not to pursue surgery or chemotherapy. Goals of care were transitioned to focus on the patient’s comfort, and he died several days later.
Dongbo Yu, M.D., Ph.D.
John E.A. Blair, M.D.
University of Chicago Medical Center, Chicago, IL
jblair2@medicine.bsd.uchicago.edu
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