ST-Segment Elevation in a Patient With Vocal Cord Cancer: A Great Mimicker.

CASE SUMMARY: Cardiac metastasis mimicking ST-segment elevation myocardial infarction is a rare "pseudoinfarction pattern." A 58-year-old man with recurrent laryngeal carcinoma presented with pleuritic chest pain and anterolateral ST-segment elevation. High-sensitivity troponin levels plateaued (70-76 ng/L). Emergent coronary angiography was deferred due to the pain's quality, the absence of dynamic electrocardiogram evolution, and bedside echocardiographic identification of a right ventricular mass. Positron emission tomography-computed tomography confirmed extensive neoplastic infiltration. This pattern results from a persistent injury current at the tumor-myocardium interface. Recognition is vital to avoid futile invasive procedures and guide appropriate palliative systemic therapy.

TAKE-HOME MESSAGES: Persistent ST-segment elevation in an oncology patient without typical dynamic evolution should raise suspicion of myocardial tumor infiltration. Multimodality imaging, particularly emergent bedside echocardiography, is essential to differentiate malignant "injury currents" from acute coronary syndromes and avoid unnecessary invasive interventions.