153 CARDIAC METASTASES: WHEN YOU HEAR THE HOOFBEATS YOU SHOULD ALSO THINK ABOUT ZEBRAS


 
 
 Cardiac metastases (CM) are rare findings and their diagnosis is often challenging due to the large panel of symptoms they can cause. CM are frequently clinically silent, and their diagnosis is frequently made post-mortem. Even in the rare cases in which they clinically manifest themselves, it's harsh to distinguish them from other (more common) cardiovascular conditions presenting with the same panel of symptoms. The diagnosis could be very challenging, in particular in subjects with occult primary neoplasm. Electrocardiogram, although not specific, is frequently abnormal and imaging tools play a key role in the diagnostic process.
 
 
 
 A 75-year-old man went to the emergency room for chest pain and fever. The pain differs from that experienced in previous myocardial infarction. Laboratory tests showed plateau rise in troponins and the electrocardiogram showed diffuse changes in depolarization and repolarization. Transthoracic echocardiographic assessment showed a non-dilated left ventricle (LV) with a huge thickening of the interventricular septum and of the LV apex. The inferior wall was akinetic and the ejection fraction of the left ventricle was 45%; diffuse pericardial effusion was also present. To characterize the nature of this finding, a chest CT scan an a Cardiac Magnetic Resonance were performed. The diagnosis of a cardiac metastasis and its occult primary lung cancer was then made.
 
 
 
 In this clinical case, metastases manifest themselves mimicking an acute coronary syndrome, albeit with atypical characteristics; the atypical symptoms and the instrumental findings made us hypothesize that we were not dealing with a myocardial infarction. The peculiarity of this clinical case lies in the fact that the onset of symptoms led to the diagnosis of the cardiac metastasis and, subsequently, of the occult primary lung tumor. Our case report warn us that, sometimes, when you hear the hoofbeats you should also have to think about zebras.
