Is cancer a risk condition for intracardiac thrombosis? A case report

Introduction: The pathogenic links between neoplas-tic disease and venous thromboembolism are well stu-died and many guidelines are currently indicating the appropriate management of the patients affected by both conditions. However, lesser data are available re-garding the association of cancer with cardiac and arte-rial tromboembolism

Methods: We present the case of a patient with acute myocardial infarction and interventricular thrombosis that was diagnosed de novo with a neoplastic disease.

Results: We are presenting the case of a 71 years old male admitted to hospital for anterior thoracic and epi-gastric pain. He had a history of smoking and in the last 2 month he presented dysphagia, emesis and a weight loss of 10kg. The patient had a cachectic appearance, but was hemodynamically stable. Due to the identifica-tion of deep negative T waves in the lateral and anterior leads on ECG and to a twice as normal level of TnI at admission he was diagnosed with myocardial infarction without ST segment elevation (NSTEMI) and dual antiplatelet therapy (DAPT) was initiated. Laboratory work-up revealed a mild anemia with criteria of ma-crocytosis, increased values for erythrocyte sedimen-tation rate, alkaline phosphatase and gamma glutamyl transferase. The coronary angiography was postponed. During the transthoracic echocardiography (TTE) we identified an echogenic mass, polylobulated, well de-lignated, attached to the middle and apical segments of the interventricular sept, in the left ventricle (Figure 1A). We have to underline that the contractility of the myocardium was slightly decreased in this segments, without an aneurysmal remodeling and the global ejec-tion fraction of the left ventricle was 45%. The anticoa-gulant treatment with fractionated heparin was added. After 7 days the ventricular mass has diminished, and after 3 weeks has disappeared, thus confirming throm-bosis over other diagnostic possibilities. On the second day of hospitalization the patient performed a superior digestive endoscopy which has revealed an obstructi-ve tumor process, which was bleeding easily, located in the inferior esophagus. The biopsy described a human papilloma virus-related esophageal cancer. The abdo-minal CT-scan confirmed the tumor and identified also secondary hepatic determinations.

Discussion and conclusions: Emergent data have hi-ghlighted a significant association of neoplasic disease with arterial thromboembolism or cardiac thrombosis. In the presented case there was a high risk of acute co-ronary event but the ventricular thrombosis was an un-expected complication in the context of acute NSTEMI with minimal motility changes. We presume that the procoagulant condition induced by the malignant tu-mor had an important contribution to thrombus ap-pearance. This case, underline the possible implicati-ons of malignancy in the evolution of acute coronary syndromes. Diagnostic challenges have been raised by the differentiation between thrombosis and secondary malignant tumors of the heart.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)