A case report: metastatic complete heart block
The following case has been reported in the European Heart Journal - Case Reports.

Though primary malignant tumours of the heart are rare, secondary metastatic affection of the heart is quite common. Common presentations include pericardial effusion, obstruction of inflow and outflow tracts and arrhythmias, most notably tachyarrhythmias, and very rarely complete heart blocks (CHBs).

A 28-year-old man suffering from carcinoma of the tongue underwent a surgery in the form of radical hemimandibulectomy. He presented with recurrent syncope and CHB with broad complex escape rhythm. After performing echocardiography, he was found to have malignant infiltration of the interventricular septum.

This was confirmed by performing cardiac positron emission tomography (PET). It was decided that a permanent pacemaker would then be implanted. Post-implantation of permanent pacemaker patient succumbed to massive haemoptysis after 5 days.

Learning points

• Patients with malignancy (especially disseminated ones) can present with rhythm disturbances.

• Although tachycardia is much more common, rarely there can be complete heart blocks can be present.

• Simple investigations like repeated ECGs and a careful echocardiogram is enough to suspect. Further confirmation can be done by cardiac magnetic resonance imaging and cardiac positron emission tomography.

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