636 - Hemodynamic instability caused by cardiac metastases of non-small cell lung cancer- case studies

Case Summary

Background: The incidence of cardiac metastases is 9.1% in oncologic patients and lung cancer is the main cause. Mostly asymptomatic, and symptoms may mimic cardiovascular diseases. Hemodynamic instability is often life-threating. Here we present two rare cases of fatal cardiac metastases from non-small cell lung cancer with hemodynamic instability.
Methods: All the data were collected from chart review.
Results: Case 1 A 66-year-old male heavy smoker presented with stage IV squamous cell carcinoma of the lung. At initial, computed tomography (CT) scan of the chest revealed low-density mass at the interventricular septum of the left ventricle. Echocardiogram showed a mass with 4x2.5 cm in size, favoring myocardial metastasis. 24-hour-Holter reported no arrhythmia episodes. He had no chest discomfort and received chemotherapy cisplatin with gemcitabine. However, one episode of syncope was noted after two courses of treatment. Echocardiogram showed an enlarged heart tumor within 2 months. Holter reported the high degree to complete atrioventricular block. He refused radiotherapy and asked for hospice care. Progressive bradycardia was noted, and he died after 3 months of diagnosis. Case 2 A 76-year-old never smoker presented with stage IIB squamous cell carcinoma of the lung. The tumor was at the right middle lobe with pericardium invasion. However, he refused adjuvant chemotherapy and asked for surveillance after surgery. Chest tightness was noted 7 months later. Chest CT showed pericardial, epicardial metastasis with an invasion of the right ventricle and encasement of the left anterior descending coronary artery. Echocardiogram revealed large mass at the apical free wall with 2.1x3.4 in size. Chemotherapy of oral vinorelbine was started. Chest tightness aggregated, and serial EKG showed ST-segment elevation due to the progression of tumor encasement. The patient died 3 months later.
Conclusions: With the advance of treatment, cardiac metastases are increasing. Physicians should be alert that new cardiac symptoms in patients with known malignancy can be caused by cardiac metastases. Although limited, some data shows early detection and multidisciplinary management in selected patients may improve the outcome.

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