Persistent ST-segment elevation due to cardiac metastasis

Description

A man aged 68 years with a known history of squamous cell carcinoma of the lung presented to the emergency room complaining of an acute episode of dyspnoea. His symptoms had resolved on presentation to the hospital. An EKG was obtained, which showed marked ST-segment elevation (STE) in the anteroseptal leads (figure 1A). No prior EKG was available for comparison. The patient denied any chest pain or pressure, and had no evidence of myocardial necrosis by cardiac biomarkers. Nevertheless, he was taken emergently to the cardiac catheterisation laboratory for a presumed diagnosis of STE myocardial infarction (STEMI). He was found to have severe two-vessel coronary artery disease with possible plaque rupture in the mid-left anterior descending artery (LAD) (figure 2). Overlapping bare metal stents were deployed to the LAD. Concerningly, the patient's right ventricle was noted to be in a fixed motion suggestive of...

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