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Challenges in Clinical Electrocardiography
March 8, 2021

ST Segment Elevation in a Patient With Myocardial Metastases: What Is Up With That?

Author Affiliations
  • 1Cardiology Division, Massachusetts General Hospital, Boston
  • 2Department of Medicine, Massachusetts General Hospital, Boston
JAMA Intern Med. 2021;181(5):695-696. doi:10.1001/jamainternmed.2021.0101

A man in his 70s with a history of multiple prior ST-segment elevation myocardial infarctions (STEMIs) and squamous cell carcinoma of the lung with metastatic disease to the brain and myocardium presented to the emergency department with progressive dyspnea on exertion. Ten months prior, the patient developed chest pain and was found to have an inferior STEMI from late in-stent thrombosis, for which he received 2 drug-eluting stents to the right coronary artery. A subsequent transthoracic echocardiogram demonstrated preserved left ventricular systolic function without regional wall motion abnormalities, a moderate pericardial effusion, and a new 2.8 × 2.6-cm mass in the left ventricular mid-apical anteroseptum consistent with a metastatic myocardial tumor (Figure, A).

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