Inferior STEMI in a Patient With Cardiac Metastasis: A Diagnostic Challenge.

BACKGROUND

Cardiac metastases occur more commonly than primary cardiac tumors but are often clinically silent. ST-segment elevation mimicking acute myocardial infarction because of cardiac metastasis is rare.

CASE SUMMARY: We present the case of an 80-year-old woman with advanced pulmonary squamous cell carcinoma and intracardiac metastasis presenting with ST-segment elevations on electrocardiogram. Coronary angiography demonstrated nonobstructive coronary disease. Presentation was thought to be secondary to myocardial infiltration leading to myocyte necrosis. Management focused on symptom control, and the patient ultimately transitioned to hospice care and passed away.

DISCUSSION: Cardiac metastases can cause ischemic electrocardiographic changes via myocardial invasion, coronary artery compression, or embolization. This case highlights a rare mimic of ST-segment elevation myocardial infarction.

TAKE-HOME MESSAGES: Cardiac metastases should be considered in cancer patients with findings of ST-segment elevation and nonobstructive coronary disease. Early recognition can guide prognosis, avoid futile interventions, and support timely goals of care discussions.