Pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction

Our plain-English summary of Pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction, by A.S. Barroso, S. Leite, F. Friões, et al (Revista Portuguesa de Cardiologia, 2017).

The study

• Authors: A.S. Barroso, S. Leite, F. Friões, M. Vasconcelos, D. Azevedo, H. Baldaia, M.J. Amorim, P. Dias
• Journal: Revista Portuguesa de Cardiologia
• Published: 2017;36(4):307.e1-307.e5
• Type of article: Case report
• Language: Portuguese
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Primary cardiac and pericardial tumors are rare entities with an autopsy frequency of 0.001-0.03%. Metastases to the heart and pericardium are much more common than primary tumors. Malignant pericardial mesotheliomas account for up to 50% of primary pericardial tumors. We report the case of a 75-year-old woman with hypertension, dyslipidemia and atrial fibrillation who went to the emergency department due to nonspecific thoracic discomfort of over six hours duration associated with syncope. Physical examination revealed a low-amplitude arrhythmic pulse, no heart murmurs and no signs of pulmonary congestion. The ECG revealed atrial fibrillation with ST-segment elevation in V2-V6, I and aVL. The patient was transferred for emergent coronary angiography, which revealed a long stenosis in the mid-distal portion of the left anterior descending artery. The echocardiogram showed a large pericardial effusion with diffuse thickening of the myocardium. Due to worsening hemodynamics, cardiac rupture was suspected and the patient underwent urgent sternotomy and pericardiotomy with drainage of a large quantity of hematic fluid. The surgeons then identified a large, unresectable tumor occupying the distal half of the anterior portion of the heart. This is, to our knowledge, the first case report of primary pericardial mesothelioma presenting with suspected ST-elevation myocardial infarction. In this case, direct observation of the tumor led to biopsy and the final diagnosis. These are highly malignant tumors and when diagnosed are usually already at an advanced stage.

Copyright © 2017. Publicado por Elsevier España, S.L.U.

In plain English

This article is a case report about one patient. A 75-year-old woman with high blood pressure, dyslipidemia (abnormal blood fats) and recently diagnosed atrial fibrillation went to an emergency department with chest discomfort lasting over six hours and a fainting episode. Her ECG showed ST-segment elevation and her cardiac troponin was raised, which pointed to a heart attack. Coronary angiography showed a 50% narrowing in one artery and a 30% narrowing in another. An echocardiogram then showed a large fluid collection around the heart. Because her blood pressure was worsening and doctors suspected the heart had ruptured, surgeons opened her chest and drained bloody fluid. They found a large tumor on the front of the heart that could not be removed. A biopsy showed malignant mesothelioma, and a CT scan showed spread to the lungs, neck and abdominal wall. She started chemotherapy and died suddenly on the 30th day in hospital. The authors reported that she had no history of contact with asbestos products. They described this as, to their knowledge, the first reported case of primary pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: one 75-year-old Caucasian woman with hypertension, dyslipidemia, a left total hip replacement and recently diagnosed atrial fibrillation
• Exposure: No asbestos exposure: the authors state the patient had no history of present or past contact with asbestos products. No fiber type is named.
• Main results:
  • The ECG showed atrial fibrillation with ST-segment elevation, and cardiac troponin I was elevated at 0.9 ng/ml (normal less than 0.04 ng/ml)
  • Coronary angiography showed a long 50% stenosis in the mid-distal left anterior descending artery and a focal 30% stenosis in the mid right coronary artery
  • The echocardiogram showed a large pericardial effusion with diffuse thickening of the myocardium
  • At urgent sternotomy, surgeons drained bloody fluid and found a large unresectable tumor on the distal half of the anterior heart, which was biopsied
  • CT showed myocardial tumor infiltration measuring 6 cm by 7 cm by 11 cm, with pulmonary, cervical and abdominal wall metastases
  • Pathology showed malignant mesothelioma, of the mixed-type cell pattern
  • Chemotherapy with pemetrexed and carboplatin was started on the eighth day of hospitalization. The patient died suddenly on the 30th day of hospitalization.
• The authors' conclusion: The authors concluded that, to their knowledge, this was the first case report of primary pericardial mesothelioma presenting with suspected ST-elevation myocardial infarction, and that direct observation of the tumor led to biopsy and diagnosis. They described these tumors as highly malignant and usually advanced when diagnosed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardial, Autopsy, Pericardium, Echocardiogram, Pericardial Effusion, Unresectable, Biopsy.

Related studies

• Rare cause of myocardial infarction, stroke, and lung tumour — M. Medvegy, A. Szekula, et al. (2013)
• Primary pericardial mesothelioma in a 19-year-old presenting as pericarditis — M.O. Kayatta, S.P. Dineen, et al. (2013)
• Pericardial mesothelioma presenting as left atrial thrombus in a patient with mitral stenosis — Y. Miyamoto, S. Nakano, et al. (1996)
• Unexpected malignant pericardial mesothelioma presenting as pericardial constriction — M. Oc, B. Oc, et al. (2012)
• Chest pain and ST elevation: not always ST-segment-elevation myocardial infarction — S.A. Pyxaras, G. Lardieri, et al. (2010)
• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)

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