Metastatic carcinoma to the pericardium masquerading as MI o
The present case has been reported in the European Heart Journal: Case Reports.

A 55-year-old male patient presented with acute onset of substernal chest pain and dyspnoea. He had a previous medical history of oesophageal squamous cell carcinoma diagnosed 1 month prior to presentation, for which he underwent chemotherapy, radiation, and oesophageal stent placement. Vital signs on presentation were notable for heart rate of 79 b.p.m., respiratory rate of 18, blood pressure 114/87 mmHg, and oxygen saturation of 100% on room air.

Initial ECG demonstrated ST segment elevations in leads II, III, aVF, V4–V6, concerning for acute ST elevation myocardial infarction in the inferolateral territory. He was taken emergently to the cardiac catheterization laboratory for coronary angiography, which revealed no occlusive coronary artery disease.

Echocardiogram revealed akinesis of the apical, lateral, and inferior walls, and a large left ventricular apical mass (4.5 cm × 2.5 cm) as well as an echogenic mass surrounding left atrium and descending aorta with evidence of external compression of the left atrium.

Hospital course was complicated by cardiac arrest secondary to pulseless electrical activity, ventilator dependent respiratory failure, and septic and obstructive shock. Further imaging to characterize the mass was limited by declining clinical status. Patient developed worsening shock and renal failure requiring renal replacement therapy.

After multiple discussions with family, the decision was made to proceed to comfort care measures and patient subsequently expired. The ST elevations on ECG persisted throughout the course of his hospital.

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