Cardiac metastasis of hepatocellular carcinoma
The following case has been reported in BMJ.

A 72-year-old man, who had been diagnosed as having hepatocellular carcinoma (HCC) with multiple extrahepatic metastasis, complained a general fatigue which appeared 2 weeks before admission.

Because bradycardia was detected on physical examination, ECG was performed which revealed the complete atrioventricular (AV) block. Ca-blocker and β-blocker were stopped, but the bradycardia persisted. He was admitted to our hospital for an emergent pacemaker implantation.

On admission, he complained dyspnoea. After the surgery, he died due to deterioration of heart failure. The autopsy revealed cardiac metastasis of HCC on AV node, so it was suspected that cardiac metastasis caused the AV block.

The authors think that the cause of his death was the exacerbation of heart failure associated with bradycardia. It was likely that complete AV block as a very rare complication caused by cardiac metastasis of HCC influenced the prognosis of this patient.

Learning points
• Cardiac metastasis of hepatocellular carcinoma (HCC) is rare.

• Cardiac metastasis of HCC occasionally cause complete atrioventricular block.

• Cardiac metastasis of HCC lead to an unfavourable prognosis and early diagnosis is important.

• Treatment for cardiac metastasis may improve prognosis.

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